Friday, August 21, 2020
TOEFL Writing Sample: Where to Get Free Writing Essays
TOEFL Writing Sample: Where to Get Free Writing EssaysYou've chosen to write an essay for your TOEFL exam, and now you're wondering where to get the best writing samples? If you take a moment to review your past essays and decide which ones were the easiest to write, you will find the best essay samples can be hard to come by.The first place you should look is at your friends who have written essays for other students and see if they can give you some sample essays to start with. Once you've learned the basics of the essay writing process, and picked out a topic, it will be easier to keep track of your learning and improve your scores over time.Getting TOEFL writing samples from other students that you respect is the best way to get started on the right foot. Your peers have already shown that they know how to write well, and they're the perfect people to show you the ropes.Of course, you need to be careful when choosing to read essay samples. You want the writer to be someone you wi ll be able to relate to on a personal level, as well as someone that has excellent writing skills.I suggest that you begin by reading samples that are designed to help you improve your writing. The books and ebooks that are available online may not seem very interesting, but they often contain tips and advice that can greatly help you as you begin your journey to becoming a better writer. They also often contain sample essays to use as a guide.The next step is to find a book or eBook that has essays that are already tested and graded. It's often best to pick a book that contains essay samples that are already scored, so that you can get a sense of what it will be like to take the test. You can also choose an essay sample that was written by someone who has already passed the test, in order to get a sense of what it will be like to write one.With all of these sample essays and books to review, it is often important to use them in conjunction with one another. If you use your essays a nd tests together, you will be able to practice and improve your writing skills and become a better writer. By doing this, you'll be able to not only complete the essay, but also to have a better chance of passing your TOEFL writing exam.While it can be helpful to pay for the TOEFL writing sample book or ebook that you choose, there are many free essay samples out there that are valuable. Taking the time to learn from these free resources will help you learn how to write a great essay on your own, without paying for a copy of a book that you can't even read!
Monday, May 25, 2020
Grounded Theory -- Definition and Overview in Sociology
Grounded theory is a research methodology that results in the production of a theory that explains patterns in data, and that predicts what social scientists might expect to find in similar data sets. When practicing this popular social science method, a researcher begins with a set of data, either quantitative or qualitative, then identifies patterns, trends, and relationships among the data. Based on these, the researcher constructs a theory that is grounded in the data itself. This research method differs from the traditional approach to science, which begins with a theory and the seeks to test it through the scientific method. As such, grounded theory can be described as an inductive method, or a form of inductive reasoning. Sociologistsà Barney Glaser and Anselm Strauss popularized this method in the 1960s, which they and many others considered an antidote to the popularity of deductive theory, which is often speculative in nature, seemingly disconnected from the realities of social life, and may, in fact, go untested. In contrast, the grounded theory method produces a theory that is based on scientific research. (To learn more, see Glaser and Strausss 1967 book,à The Discovery of Grounded Theory.) Grounded Theory Grounded theory allows researchers to be scientific and creative at the same time, as long as the researchers follow these guidelines: Periodically step back and ask questions.à The researcher needs to step back once in a while and ask the following questions: What is going on here? Does what I think I see fit the reality of the data? Data does not lie, so the researcher needs to make sure their own ideas about what is happening matches what the data is telling them, or the researcher may need to alter their idea of what is going on.Maintain an attitude of skepticism.à All theoretical explanations, hypotheses, and questions about the data should be regarded as preliminary, whether they come from the literature, experience, or making comparisons. They should always be checked out against the data and never accepted as fact.Follow the research procedures.à Research procedures (data collection, analysis, etc.) are designed to give precision and accuracy to a study. They also help the researcher break through biases and lead him or her to examine some of his or her assumptions that might otherwise be unrealistic. Therefore, it is important that the correct research procedures are followed so that an accurate conclusion is reached. With these principles in mind, a researcher can construct a grounded theory in eight basic steps. Pick a research area, topic, or population of interest, and form one or more research questions about it.Collect data using a scientific method.Look for patterns, themes, trends, and relationships among the data in a process called open coding.Begin to construct your theory by writing theoretical memos about the codes that emerge from your data, and the relationships among codes.Based on what you have discovered so far, focus on the most relevant codes and review your data with them in mind in a process of selective coding. Conduct more research to gather more data for the selected codes as needed.Review and organize your memos to allow the data and your observations of them to shape an emergent theory.Review related theories and research and figure out how your new theory fits within it.Write your theory and publish it. Updatedà by Nicki Lisa Cole, Ph.D.
Thursday, May 14, 2020
The Trial of Socrates - 1543 Words
In the trial of Socrates, I juror number 307, Ryan Callahan vote the defendant is Not Guilty on the first charge of Corrupting the youth. My justifications for this vote are as follows. Socrates didn t corrupt the youth, he just shared his ideas with them and they in turn chose the path to take these ideas. Part of understanding this case is understand the time in which the case was held. This time being 399 B.C., a time in which Athens was a free democratic city, a town which prided itself at the time on the fact that its citizens had much freedom, particularly freedom of speech. Socrates believed that only people who were educated should rule the people, which meant that people were not capable of government participationâ⬠¦show more contentâ⬠¦On top of all that when the arrogant Socrates went on trial he left the jury no choice but to find him guilty so he played right into their hands. So to sum up the trial, the charges against him were officially two, corrupti ng the youth and impiety. The two charges were, of course, linked, and, in the relevant senses, he was, we must admit, guilty of at least one of them. For his effect on the lives of the young men who followed him was indeed disrupting, and even corrupting, of the social order. What his followers learned from him above all else, is to do two things. They learned to scrutinize, and they learned to be skeptical. It was not that they mindlessly adopted a motto like trust no one over 30, or that they became, like many of today s young people, contrary simply for the sake of being contrary. Rather, they learned not to take on authority or on faith what others told them about virtue, justice, or piety; they were seeking, as was Socrates himself, the truth of the matter and the reasons for taking it to be the truth of the matter. And as we all know, the relentless pursuit of the truth produces enemies. A Socrates may in the long run serve mankind, but in the short run he aggravates virtu ally everyone around him. Socrates was thus put to death for teaching others to scrutinize and be skeptical about what they are told, andShow MoreRelatedTrial of Socrates914 Words à |à 4 PagesTrial of Socrates What do Jesus, Joan of Arc, Martin Luther King Jr., and Socrates all have in common? All of them died for their beliefs. The Trial of Socrates depicts a scene where Socrates is in prison condemned to death and he is speaking with an acquaintance Crito. Socrates is being put to death because he was charged with corrupting the youth and not acknowledging the gods. Although over the course of the trial Socrates has numerous opportunities to evade the death penalty, he doesRead MoreTrial of Socrates1059 Words à |à 5 PagesSocrates was a great philosopher of the Greek world. He was quite an atypical and distinctive person. Being different from all the other philosophers of the land, Socrates was teaching his students ideas totally out of the ordinary from what the society believed was right. As a result, he displeased many people so much that they decided to get rid of him. Socrates was put to trial, accused of spoiling the youth of Athens, tried and sentenced to death. His person al defense is described in works twoRead MoreTrial of Socrates1073 Words à |à 5 PagesSocrates was a great philosopher of the Greek world. He was quite an atypical and distinctive person. Being different from all the other philosophers of the land, Socrates was teaching his students ideas totally out of the ordinary from what the society believed was right. As a result, he displeased many people so much that they decided to get rid of him. Socrates was put to trial, accused of spoiling the youth of Athens, tried and sentenced to death. His personal defense is described in works twoRead MoreThe Trial And Death Of Socrates : The Trial And Death Of Socrates972 Words à |à 4 Pages The Trial and Death of Socrates, depicts the different stages of Socratesââ¬â¢s life, from his prosecution until his execution. During the narratives, Socrates gives us, as readers, insight towards his beliefs and philosophy, which are viewed as reasons for his imprisonment. Phaedoââ¬â¢s recollect ion of Socratesââ¬â¢s last few hours alive, reveals Socratesââ¬â¢s most important belief, that the soul is an entity which is immortal and is valuable during and after life. All perceived lusts, greed, and fear are causedRead MoreSocrates Trial Essay662 Words à |à 3 PagesSocrates Trial In 399 B.C., Socrates, a seventy year old man, was brought to trial. He faced several accusations of different sorts. Initially, the court had pronounced Socrates guilty. However, because the law had no penalty ordained for his offense, it was required of Socrates to propose his own penalty, or to take the one suggested by Meletos, the death penalty. When the time had come for Socrates to state his defense, he addressed each of the accusations made against him, one by oneRead MoreSocrates Trial Essay807 Words à |à 4 PagesApology Socrates was charged and put on trial for impiety, as well as accused of committing many other crimes. I will first explain the most important issues of why Socrates was sent to death. Then I will argue the position that Socrates is innocent, and should not be have been found guilty. To introduce, Socrates was placed on trial and charged with the crime of impiety. Impiety is the lack of reverence for the gods and other sacred things. As well another major claim was that Socrates was corruptingRead MoreThe Trial And Death Of Socrates845 Words à |à 4 Pagesright or not. For that, in this essay, we will use Platoââ¬â¢s The Trial and Death of Socrates, as our example of how this kind of attitudes play in Socratesââ¬â¢ life as it is well-known as intelligently and morally lived one. In Euthyphro section, Socrates meets a man named Euthyphro before his trial, where he is being accused by Meletus for corrupting the youth. While Euthyphro is here to prosecute his own father for the case of murder. Socrates starts to ask him about his meaning of piety. ââ¬Å"It is notRead MoreThe Trial And Death Of Socrates1701 Words à |à 7 PagesIn reading, The Trial and Death of Socrates, Socrates presents himself against ââ¬Å"the majorityâ⬠and endures prosecution for inventing new gods and not believing in old ones. Socrates lives a life that is opposite of much of the ââ¬Å"the majorityâ⬠ideals. ââ¬Å"The majorityâ⬠values goods, possessions, and uncontrollable attributes given to them by others such as a high reputation and honor. In addition, The Greek Philosopher was able to refuse the opportunity to escape his death sentence while he had sons atRead MoreTrial and Death of Socrates2267 Words à |à 10 PagesBenjamin Jowett. The Trial and Death of Socrates (Dover Edition). New York: Dover Publications, 1992 ââ¬Å"What is the charge? Well, a very serious charge, which shows a good deal of character in the young man, and for which he is certainly not to be despised. He says he knows how the youth are corrupted and who are their corruptors. And I fancy that he must be a wise man, and seeing that I am anything but a wise man, he has found me out, and is going to accuse me of corrupting his young friendsRead MoreThe Trial and Death of Socrates Essay1639 Words à |à 7 PagesThe portrayal of Socrates, through the book ââ¬Å"the trial and death of Socratesâ⬠is one that has created a fairly controversial character in Western history. In many ways, Socrates changed the idea of common philosophy in ancient Greece; he transformed their view on philosophy from a study of why the way things are, into a consideration man. Specifically, he analyzed the virtue and health of the human soul. Along side commending Socrates for his strong beliefs, and having the courage to stand by those
Wednesday, May 6, 2020
Concept Comparisons and Analysis Theories - 1667 Words
Concept Comparison and Analysis across Theories UOP Theoretical Foundations of Nursing NUR/513 Concept Comparison and Analysis across Theories Nursing theory is relatively new and as such, it continues to evolve as new knowledge is gained. There are numerous theories of nursing, each of which took years to develop and most of which continue to evolve and adapt. There are commonalities between and among the existing theories although each may focus more heavily on different aspects of responsibilities. It has to do with the philosophical foundations for each theory. Moore, (Moore, 2008) reported a nursing metaparadigm of four basic concepts: person, health, environment, and nursing. Another author suggested the coreâ⬠¦show more contentâ⬠¦Exactly where they are on the continuum is determined by the balance found in each of the five factors in the metaparadigm (Tourville and Ingalls, 2003). For example, how a person reacts to stressors has a great impact on their health. It is the nurses responsibility to help the patient restore balance and stability of the five fa ctors (Tourville and Ingalls, 2003). This is very similar to the nurses responsibility according to Orem. It also reflects the metaparadigm on nursing theories as well as the core concepts as presented by others. Jean Watsons theory of nursing is based on the ideas of a number of philosophers and psychologists, including Carl Rogers, most specifically on his phenomenological psychology and philosophy (Tourville and Ingalls, 2003, p. 21). Her theory evolved over at least two decades of diverse experiences. Watsons theory is referred to as Transpersonal Caring because it emphasizes unity in the world (Tourville and Ingalls, 2003). Watson proposed that caring is a natural act for humans and it becomes a moral principle at the point when a patient and a nurse share a caring experience (Watson 2007). According to Watson, the goal of nursing is to help the patient achieve harmony of mind, body and spirit (Watson, 2007). To apply Watsons model, a nurse needs to create a shared caring experience with a patient. This shared experience will lead to better outcomes for the patient as well as aShow MoreRelatedConcept Comparison and Analysis Across Theories1051 Words à |à 5 PagesConcept Comparison and Analysis Across Theories Nur 513 May 19, 2014 Theory is the core of nursing and nursing process. It describes, explains and predicts the uniqueness of a phenomenon. Theory is analysis and examine to determine the viability in the world of professional nursing. Concepts is the framework and foundation of the theory which consist of concrete and abstracts. The purpose of this paper is to select a core concept that is common to two nursing theories. Compare and AnalysisRead MoreConcept Comparison and Analysis Across Theories1882 Words à |à 8 PagesConcept Comparison and Analysis Across Theories Julie McKay NUR/513 Theoretical Foundations of Practice December 06, 2014 Stephanie Vaughn Ph.D. R.N. CCRN A concept is a term that theoretically describes and names a fact or phenomenon, thus providing it with a separate identity or meaning. Nurses use theories to clarify the events through nursing practice. A concept analysis provides insight to nursing knowledge and understanding of the concepts allows nurses to determine nursing actionsRead MoreConcept Comparison and Analysis Across Theories1775 Words à |à 8 PagesConcept Comparison and Analysis Across Theories Ryan Velasco University of Phoenix NUR/513 March 13, 2012 Noura Kassis Ed.D., R.N. Concept Comparison and Analysis Across Theories Nursing as a profession has evolved through the contributions of practicing nurse theorists who have worked rigorously toward improving the way nurses approach the art and science of nursing. Through theory development, nursing models, and their conceptual frameworks, they have provided a foundationRead MoreConcept Comparison and Analysis Across Theories1773 Words à |à 8 PagesConcept Comparison and Analysis across Theories ââ¬Å"Nursing theory is the term given to the body of knowledge applied to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designingRead MoreConcept Comparison and Analysis Across Theories Paper1713 Words à |à 7 PagesConcept Comparison and Analysis across Theories Paper NUR 513 August 6, 2012 Comparison and Analysis Theories Paper The heart of nursing has always been caring. Since the start of professional nursing with Florence Nightingale, theorists have been writing about caring. This paper highlights three caring theories Madeleine Leininger, Jean Watson, and the combine theory of Patricia Benner and Judith Wrubel these theorists each has developed a theory of caring. ThisRead MoreConcept Comparison and Analysis Across Theories Essay1793 Words à |à 8 PagesConcept Comparison and Analysis Across Theories NUR/513 October, 22, 2012 Delores Diehl Concept Comparison and Analysis Across Theories Nursing is a science that has many theories to support the beliefs and clinical practice of the profession. One core concept prevalent in many nursing theories is caring. Theorist Jean Watson and Madeleine Leininger are both nursing theorists who developed theories around caring and nursing. The subject of discussion in this paper is the comparison and analysisRead MoreTheories And Theories Of Nursing Essay1211 Words à |à 5 PagesMcEwin and Ellis, theory in nursing ââ¬Å"offers structure and organization to nursing knowledge and provides a systematic means of collecting data to describe, explain, and predict nursing practiceâ⬠(McEwen Wills, 2014, p. 25). Theories in nursing are what distinguish it from other professions and help to create professional boundaries (McEwen Wills, 2014)Click and drag to move. When theories are applied in the nursing process, there are various concepts from the respective theory that are introducedRead MoreThe Logic Of Grounded Theory And Init ial Coding Essay1372 Words à |à 6 PagesThe book by Kathy Charmaz is successful in the sense of presenting concepts regarding the knowledge of the construction of grounded theory. For researchers in the field of education, this book plays a crucial role as one significant tool for reference. To understand the assertions of Charmaz and the rich knowledge presented in the book, it is significant for one to carry out chapter-by-chapter reading. Therefore, with this analysis, it is also significant for one to make a succinct summary of theseRead MoreApplication Of Concept Analysis For Clinical Practice1414 Words à |à 6 PagesApplication of Concept Analysis to Clinical Practice The article selected for the Application of Concept Analysis to Clinical Practice was the article named ââ¬Å"Nurse Competence: A Concept Analysisâ⬠by Ms. Sarah Smith. The articleââ¬â¢s purpose is to deduce the use of Rodgersââ¬â¢ evolutionary method and how it pertains to nursing. The article states that nurse competence is not a destination but rather a journey that gets longer the more you learn (Smith, 2012). This article establishes that, by obtainingRead MoreA Critical Comparison Of Marxist Theory And Mertonââ¬â¢S Strain1530 Words à |à 7 Pages A Critical Comparison of Marxist Theory and Mertonââ¬â¢s Strain Theory of Deviance. Introduction: This particular work will consist of a critical theoretical review and a comparative analysis on two criminological theories. For the comparison I have chosen Marxââ¬â¢s theory of crime and Mertonââ¬â¢s strain theory of deviance. My critical comparison analysis will emphasise the central concepts and arguments within both theories and how each theory explains crime. The analysis will then explore modern day
Tuesday, May 5, 2020
By Yonas SD Essay Example For Students
By Yonas SD Essay . 2007 AAUIntroductionThis research is conducted on the conflict management resolution techniques of Organization of African Union in comparison to African Union commission. Its aims are describing and analyzing the different methods techniques of these two institutions adopted to obvert resolve conflict .Besides the research aimed to suggest on the peace keeping peace building mechanism of these institutions in comparison to one another. Statement of the problem;Numerous conflicts in Africa, among the worst in world history, had been seen. Particularly after the end of cold war the scourge of violence has shown remarkable augmentation. Mean while international involvement to resolve Africa problems became least due to; insufficient political will of the international community, multiplicity of African conflicts, extended responsibility of international institutions, the setbacks it encounter (1993 in Somalia) are some of the factors. Presence of many ethnic groups nationalities exc eedingly contributed for the mushrooming of ethnic other inter state conflict in the continent. Border conflict which is a colonial heritage ravaged the continent for a long period of time. ObjectiveThe basic objectives of this paper are:To show the importance of having regional mechanism for conflict prevention, management, resolving as well as maintaining ,promotion of peace security as well as stability on the continent. To identify similarity differences of OAU AU conflict management mechanismTo analyze their fragile side and sturdy side in order to suggest other possible means of forestalling conflict establishing sustainable peace in the continent. Significance of the studyThis research is significant in three ways. Preliminary it serves as a guide on haw important it is having regional arrangements on the maintenance of international peace security. Secondly, the evaluation of their techniques can clearly show as where the blunder was committed by the institutions, and thirdly it tells as haw to restructure in the direction of improving the mechanisms. Besides it can be used by concerned bodies as groundwork for further study. LimitationsAmong many limitation s that I faced during my research the inaccessibility of archive materials individuals has above reaching impact on the research .Until now many documents are exclusives for such kinds of studies. The short period of the AU life span doesnt permit as to make deep evaluation on its performance. Never the less we have tried our greatest endeavor to fill the gapes from other sources techniques. Methods We employed primary courses such as referring the protocol of the establishment of Au the protocol of the peace Security Council of the AU the constitution of the African Union. Books on conflict conflict resolution are widely used during the research .Internet sources as well as policy documents were our other target during the research. BackgroundAfrica is made up of many list developed countries. It is a place for many conflicting factors. There are many factors to make the continent the arena for so many wrest conflicts in history. The artificial boundaries devised many of the African countries is one major factor for intense numerous inter- state conflicts in Africa. Secondly, the existence of difference economic inequalities socio economic declines side by side with economic regressions are major factors for intense inert state as well as intra state conflicts. Thirdly, absence of national state with the exception of Swaziland, Somalia, Lesotho, Tunisia is one factor that precipitates conflict. Besides conflict over the definition and implication of self administration caused the most exhausting extravagant civil wars in the continent. Demand of the majority for democratic representation is also another factor that precipitates internal conflict. The best example is the case of Eritrean succession war the so ca lled thirty years war of Africa that took lasted for 30 years 1962-1992.However, acute nationalism ?nic conflicts are spreading at an alarming rate. Fourthly, ideological socio political deference among African countries during the cold war period affected their relations negatively. Some even drown to deep conflict. The Ethio- Somalia war of 1977-78 had a touch of this factor in addition to the irredentist action of Somalia. Fifth, religious difference ethnic diversity inside among African countries is the deadly dynamic for copious inter state and intra state conflicts. In other words ethnic based conflicts assertion of an ethnic group either minority
Tuesday, April 7, 2020
Alexander The Great Essays - Free Essays, Term Papers
Alexander The Great Essays - Free Essays, Term Papers Alexander The Great Alexander the Great and His Achievements Alexander the Great was the king of Macedon. Alexander of Macedon, or ancient Mecadonia, deserves to be called the Great. Alexander the Great was considered one of the greatest military geniuses of all times. He was an excellent king, general, and conqueror. During his thirteen-year rule he conquered almost all the then known world and gave a new direction to history. He had established an empire after he died. His new empire helped many people live their lives. He improved the way of life in his empire in many ways. Conquering other lands spread the Greek traditions and language. Alexander the Great was born in Pella, the ancient capital of Macedon (Martin 192). He was the son of Philip II and Olympias. Philip II was the king of Macedonia and Olympias was the princess of Epirus (Stewart 18). Alexander had many interests in military strategies (Stewart 20). Once when Alexander was about seven years old, a group of Persian diplomats came to Macedon to see Philip. Philip was with his army fighting neighboring tribes so the diplomats stayed and talked with Alexander. They didn't except Alexander to ask questions about the size of the Persian army and the length of the journey to Susa (an important city in Persia). This shows one of Alexander's early interests (Stewart 21). Philip decided to buy Alexander a racehorse when Alexander was ten or eleven years old. The horse was named Bucephalas. Bucephalas' behavior did not please Philip. Philip ordered the horse's owner to take the horse away but Alexander declared that he could tame the horse (Stewart 21). Everyone applauded when they saw Alexander ride the horse. The rest of the company broke into applause, writes Plutarch, while his father, we are told, wept for joy, and when Alexander had dismounted he kissed him and said, 'My boy, you must find a kingdom big enough for your ambitions. Macedon is too small for you' (Stewart 22). Alexander needed more than horsemanship and self-confidence to be a good king. He needed discipline. Philip worried that Olympias spoiled the boy too much. For Alexander to learn those things, Philip hires a stern and a tough tutor to teach Alexander. His name is Leonidas. He monitored Alexander's meals and exercises. Leonidas didn't trust Olympias. He suspected she tried to smuggle extra food in Alexander's marching gear. The man [Leonidas] himself used to come and look through my bedding boxes and clothes chests, Alexander wrote, to see my mother did not hide any luxuries (Stewart 22). Philip knew that Alexander needed more training. Philip sent for a teacher who was probably the wisest man in all of Greece. His name was Aristotle. Aristotle was born in a small township of Stagira in northern Greece (Barnes 3). Aristotle was a Greek philosopher and scientist. He is considered the most famous ancient thinkers (Barnes 3). When Aristotle was seventeen years old he moved to Athens, where he became a member of Plato's school. He stayed at Plato's academy for twenty years. Aristotle left the Academy when Plato died. Aristotle founded his own informal philosophical school in Athens. Aristotle lectured on nearly every branch of learning: biology, medicine, anatomy, psychology, meteorology, physics, chemistry, mathematics, music, metaphysics, rhetoric, political science, ethics, and literary criticism. Aristotle defined and classified various branches of knowledge. He sorted them into physics, psychology, rhetoric, poetry, and logic. He laid the foundation of the most of the sciences of today. He collected the first great library and established a museum (Martin 182). In 342 B.C. Philip invited Aristotle to teach his thirteen-year-old son Alexander. Aristotle's main love was philosophy. Alexander and Aristotle's discussion about philosophy laid the foundation for Alexander's ideas of what it meant to be a soldier and a king. Alexander learned from Aristotle the principles of zoology and botany. Alexander enjoyed literature most out of all the lessons Aristotle taught. Aristotle introduced the boy to the best poets and writers (Stewart 22-23). Alexander loved the work of Homer. The Illiad was Alexander's favorite. The tales of adventure, love, bravery, and loyalty excited Alexander. Aristotle gave Alexander a copy of the poem. Alexander carried the book everywhere and put it under his
Monday, March 9, 2020
Pathogenesis of measles virus infection The WritePass Journal
Pathogenesis of measles virus infection Introduction Pathogenesis of measles virus infection IntroductionInfection and SpreadSymptomsVaccinationSubacute sclerosing panencephalitisConclusionRelated Introduction The development of the measles virus in earlier childhood is still relatively commonplace today in lower economic countries. A vaccination was developed approximately 40 years ago which reduced the incidence of the virus Worldwide. Unfortunately the virus has not been entirely eradicated, and a higher rate of infection still occurs more frequently in developing countries. In 2006 an invention of strategies were put into place by the World Health Organisation (WHO)/United Nations Childrenââ¬â¢s Fund (UNICEF)for the reduction of measles mortality rates1,2. Eradication of the measles virus encounters considerable imposing obstacles, including the growth in populations, demographic difficulties and the general populationââ¬â¢s awareness to vaccination safety3. The WHO in 2012 plan to eradicate measles virus in the Western Pacific, a well designed sustainable plan is an necessity for this to ensure achievement, another decisive influence in the successfulness of the immunisation pro ject is identifying the appropriate age at which immunisation should occur at. One of the main approaches to eradication of the measles virus infection is to immunise approximately 95% of the population, subsequently the majority of the population is acutely immunised against the measles virus infection which can cause astounding complications1. Infection and Spread Initial immunity for the neonate is maternal immunity transferred during pregnancy from mother to foetus. Younger women are being vaccinated in developing countries; consequently their own natural immunity is lower in comparison to non vaccinated women800. The measles virus is a contagious infection. The measles virus is caused by RNA viruses, which belongs to the genus Morbillivirus. Spread of the virus occurs due to coughing, sneezing, and personal contact with the infected. The measles virus can remain in an active state up to two hours once airborne or on contaminated surfaces. Prior to the characteristic rash associated more commonly with the measles virus, spread of the virus can develop from up to four days prior to first signs of infection and even up to four days after initial first signs of characteristic rash801. The initial symptoms of the virus display characteristics from 8-12 days following infection802. Measles virus spread is achievable through susceptible individual s whose immune system is in a state of compromised condition. Initial spread is initialised through the airways. Replication of the measles virus (MV) is acquired through numerous organs and tissues. à Various types of cells and tissues are affected, which include dendritic cells (DC), and B and T lymphocytes. Generally the patientââ¬â¢s own immune system fights the infection and generates a life term of immunity against the infection and reoccurrence. à The MV is characterised as an RNA envelope virus. à Viral RNA continues to infect after initial 20 days after infection clearance. An indication of measles virus is a rash which manifests itself after approximately 10 days. Measles rash is an indication of the adaptive immune system responsiveness. At this stage CD4+ and CD8+ T cells infiltrate site for clearance. Both lymphocytes activate at same time, but CD8+ T cells is more severe, CD4+ response is longer.à A diagnostic serum test for presence of IgM can be taken at this stage to evaluate the prognosis of measles. Antibody specific IgG is also produced at this interval. The immune system experiences prolonged immunosuppression. Differential amounts of cytokines and chemokines are produced at the varied stages of infection. After the initial infection levels of IL-8 increase, IFN-à ³ and IL-2 are elevated by activation of CD4+ and CD8+ T cells during features of a rash. Following rash exposure CD4+ generates interleukin IL-4, IL-10, and IL-13. Failure to eliminate measles infection can contribute in the development of inclusion body encephalitis and pneumonia. Subacute sclerosing panencephalitis (SSPE) can also develop from persistent infection exposure in young children203. Symptoms The measles virus presents itself as a collaboration of symptoms, which are deemed characteristics of the virus and its associated effects on the patientââ¬â¢s body and immune- suppressed system. Measles virus is considered a highly infectious disease. If the measles virus is persistent in the body, the virus can affect the central nervous system (CNS). Initial symptoms of the measles virus include a state of fever, coughing and a rash with small bumps. One of the main complications of persistent measles virus is the influence on the CNS40. The virus conforms to a number of characteristics. These characteristics include such signs as a fever, redness of the eyes with the most common feature being a rash on the skin41. Other symptoms of the virus include such features as coughing, muscle pain, runny nose, spots inside of mouth (Koplikââ¬â¢s spots), light sensitivity and eye irritation. The trade mark rash usually starts at the top of the body and moves down systematically41a. Diagnosis of acute measles include serum based specific IgM EIAs42. In 2000 a uniformed quality assured system was introduced by the World Health Organisation (WHO). The WHO established LabNet to create a homologous system to ensure diagnosis of measles and rubella. Laboratory Network (LabNet) is available in over a hundred countries. One major hurdle in the successfulness of diagnosis; is the collecting of the serum samples. Newly devised methods of sampling specimen included dried blood spots (DBS) and oral fluid (OF). Serum sampling is considered to quintessential standard for diagnosis but successful alternatives are being sought, which include the promising DBS and OF. These DBS and OF diagnostic tests offer viable potential in diagnostics for measles. Transport considerations would be less tedious when not using serum samples and the issues surrounding the safety and necessity of using needles would be eliminated. Great number of research is being implemented into more effectiv e and conclusive methods for the diagnosis of measles43. As the WHO has implemented plans to eliminate measles, greater attentiveness to the diagnostics of measles is essential and required for the WHO to be successful in their plan for reduced mortality rates44. Complications of the measles virus have been attributed to autism in children after they have received the mumps, measles, and rubella vaccine (MMR). Studies conducted suggest that the cases of autism did not increase at the period of administration of the MMR vaccine. Variation in different types of autism is being studied in comparison to administration of the MMR vaccine45. The link between MMR vaccination and autism is unauthenticated but cases could exist if the child was genetically predisposed after receiving the vaccination. The vaccine is significant, as without it mortality rates would prevail46. Vaccination The implementation of vaccinations against the measles virus has been one of the most successful vaccinations worldwide. The measles vaccine has saved millions of lives around the world. It has been estimated that approximately 30-40 million people of cases of the virus each year still occur with approximately 800,000 deaths a year being contributed to the virus. The susceptibility to the measles virus is directed towards numerous influential contributory factors. The efficacy of the vaccine is dependent of a number of influential factors. Transfer of maternal antibodies occurs through the placenta. The rate of maternal antibodies in less developed countries has been shown to be lower than transferred maternal antibodies in developed countries. One contributory factor is malaria placenta infection. It has been documented that maternal antibodies still are transferred, but these antibodies tend to diminish at a greater rate. à An implementation plan of action was the introduction of malaria netting which may improve the outcome. Low birth weights are more vulnerable to measles virus than normal healthy weight births. Suggestions put forward mitigate plans to vaccinate the more susceptible at an earlier age. Due to near elimination of naturally occurring measles, most immunity is due to vaccination, fewer antibodies get passed through placenta to the foetus, therefore the foetus immunity to measles is lower. Another suggestion to improve vaccination rate success is to vaccinate pre- adolescence to increase antibody levels. Finding a suitable age of vaccination is paramount and difficult, as vaccinated mothers pass on fewer antibodies than mother who naturally incurred the measles virus. An established immunisation programme has to be introduced which embraces all age groups and range of immunity. à Due to lower antibody levels being transferred from the mother, the measles virus susceptibility could be as low as 4-5 months for the child. Due to such a young age of susceptibility, new regimes will have to be adapted to incorporate capturing of the earlier infected age group. The number of doses required and the efficacy of the doses is also of concern. Some countries have adopted a two dose strategy and other countries have a one dose strategy. à The World Health Organisation (WHO) recommends a two dose strategy200. The different strains of the vaccines allows for different groups to be immunized. Non-injectable vaccine for the measles virus is being studied. Aerosol vaccine is displaying promising results. A study is presently on going to determine the sufficiency of aerosol vaccine in comparison to the injectable vaccine. Aerosol vaccine promises great expectations, allowing greater immune response for children 9 months or older. Aerosol vaccine allows for self administration, are less audacious to use than the injectable vaccine201. A needle-free approach is being investigated, which would prove to be cost effective and an alternative to the injectable vaccine202. A needle- free approach may be one of the better options going forward as there are numerous constraints of the live attenuated vaccines (LAVs), which include qualified administrators of vaccinations, sterile needles, and correct storage of vaccines. Non needle vaccines could allow for lower costs for administrating, easily administrated, little maintenance, one dose vaccine, safe and globally effective and availa ble.203 Subacute sclerosing panencephalitis Subacute sclerosing panencephalitis (SSPE) is contributed to the association of the measles virus. SSPE is a fatal neurological infection affecting the central nervous system (CNS), which mainly affects children. As the disease progresses, oligodendroctyes, astrocytes and endothelial cells become affected, this ultimately accumulates to death of the patient. à The occurrence of SSPE was once considered to occurs in approximately 1:300,000, but more recent research would suggest cases of 1:10,00055. The direct cause of SSPE is still unidentified56 Thepathogenesis of Subacute sclerosing panencephalitis is still undefined but the incidence is considered to be mainly an adaptive immune response which involves cell- mediated responses and antibody- mediated responses, but some research suggests that both the innate and adaptive immune response is involved57,58. SSPE can linger for a number of years while causing neurological damage. Signs of SSPE become evident 6 years post measles infection. It has been documented that 95% of patients with Subacute sclerosing panencephalitis will die within 5 years of initial determination of the disease, and with only 5% of patients going into remission. The treatment Subacute sclerosing panencephalitis includes the controlling of seizures. Diagnoses of Subacute sclerosing panencephalitis are associated with electroencephalography. Demyelination and the prevalence of the measles virus are involved with SSPE. Some treatment trials are ongoing and include such drugs as isoprinosine57. Symptoms of Subacute sclerosing panencephalitis include changes in behaviour, reduction in mental capacity and involuntary twitching. Symptoms can also be represented by non conforming characteristics, which can cause SSPE to be a missed diagnosis59. Subacute sclerosing panencephalitis has also been documented to be more prevalent in males60. Future treatments for Subacute sclerosing panencephalitis include optimising the use of antivirals and molecule inhibitors61. The administration of alpha-interferon could increase the rate of mortality among patients of SSPE62. Combination therapy has been utilised in hoping to achieve the best treatment approach available, IFN-alpha and ribavirin has been optimised but with minute improved outcome63. Other research has been conducted based on apoptosis (programmed cell death) and Subacute sclerosing panencephalitis, again combination drug therapy optimising flupirtine and antiviral drugs has been acknowledged64. The aetiology of Subacute sclerosing panencephalitis is unknown, but is contributed to the relentless measles virus65. The measles virus is attributed to an array of neurological diseases66. With advancing new methodologies being discovered, advancing research and improvements directed towards disease diagnosis into SSPE, new treatments and preventative measures a viable cure may one day may become notably and genuinely palpable67. Conclusion Measles virus is contagious and affects impoverished countries more readily than developed countries. Alternative therapies focus on the influential factors which may determine susceptibility, such as deficiency in vitamin A. Measles virus in children with vitamin A deficiency may prove more harmful. à The World Health Organisation set a recommendation of the required dosage of vitamin A for children with the measles virus living in impoverished surroundings30. Treatments for the contagious measles virus include vaccinations. Newly improved methods of vaccine administration are being developed, enhancing the cost- effectiveness and ease of use. The consequences of MV include Subacute sclerosing panencephalitis (SSPE), pneumonia and inclusion body encephalitis. Preventable measure and characteristic features of the virus should be dispensed to the public to educate the people on the importance of vaccination against measles virus. Reduction of two-thirds of deaths of the under-five is planned by the World Health Organisation, in its plan referred to as the Fourth Millennium Development Goal (MDG 4) by 2015. Elimination of the virus is being benchmarked against getting pre-puberty women vaccinated and aiming to vaccinate children at a younger age. Global recognition around the world on the severe consequences of the virus is essential for the eradication of this preventable infection. Countries around the World must be capable of alerting the ir appropriate agencies if a measles outbreak is thought to have occurred, failure of recognition could be detrimental to the more suscepitable31. A global uniformed approach to dosage to the young should be widely implemented around the World, and the consequences of a measles outbreak should be made clear to leading government agencies to cascade to their appropriate teams of experts.
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