The life of James Derham Essay Example for Free

The life of James Derham Essay James Derham is identified as one among the ten most famous male nurses in the history of mankind (National Institute of Health). He is indeed termed as the first African-American to practice formal medicine in America despite the fact that he owned no M. D. degree. Derham was born in Philadelphia, Pennsylvania by a slavery couple (Kirschman). Being a slave, he was owned by many medical practitioners, one of whom was Dr.  Robert Love, who identified Derham unique potential and encouraged him to practice medicine. With permission for his master, Dr. Robert Love, Derham successfully worked as a nurse, managing to by his freedom from slavery in 1783 (Kirschman). Being a freeman, he went on to open a medical practice. It is estimated that at the age of 26, Derham was earning over $3,000 annually from his medical practice (National Institute of Health). This has been closely attributed to large patient pool he enjoy owing to his ability to speak various languages. He was fluent in speaking English, French, and Spanish languages. It is claimed that Derham once met with the father of American medicine, Dr. Benjamin Rush, with whose encouragement he moved to continue his medical practice in Philadelphia (Kirschman). In Philadelphia, Derham emerged as a medical expert mainly dealing with the treatment of throat and climate caused diseases. He is given great honor for his historical contribution on the relationship between climate and diseases affecting mankind (National Institute of Health). However, James Derham disappeared in 1802 and no available information about his fate. He his believed not to have had married by the time he disappeared (Kirschman). Due to his honor, the state of New Orleans established the James Derham middle school in 1960. Derham was and still is a hero of the American history.

Sedaris Essay Through the Readers Eyes Essay Example for Free

Sedaris Essay Through the Readers Eyes Essay David Sedaris’ â€Å"Me Talk Pretty One Day† adds a comedic touch to his experience of learning a foreign language. The essay takes place in France where he is taking a French class to learn the language; he believes this class will be simple. His professor verbally attacks each student, which defeats Sedaris’ spirit for learning the language. He recognizes his language skills are not up to par with his classmates so he studies every night. He then stops participating in class because he feels that everything he says is incorrect. Sedaris realizes learning a language can’t be done with just textbook concepts but with understanding the language itself through experience. Sedaris uses descriptive language and comedy to appeal to his audience and keep them interested. Sedaris uses descriptive language to keep the readers interest through the story. When a classmate fails to know a verb tense Sedaris described that â€Å"the teacher poked her eyelid with a freshly sharpen pencil† (585). Sedaris uses words that describe the scene exactly as the reader would see it through their own eyes. He uses colorful words to paint a picture in our minds. This descriptive language keeps the reader alert to what is happening in the essay. Also in Sedaris’ essay, since he does not completely understand what his teacher says he creates jargon to substitute for some of the words. Sedaris’ writes, â€Å"If you not meimslsxp or lgpdmurct by this time, then you should not be in this room† (555). Having jargon in the essay keeps the readers engaged because at first glance you may over look these words, but looking deeper you see that Sedaris really doesn’t understand the key words his professor is saying. Sedaris essay is uneventful and could be characterized as dry but with his humor it helps bring the essay to life to keep the reader on their toes. His style of writing grabs the reader’ attention and keeps it throughout the essay by using humor and painting a picture. Worked Citied Sedaris, David. Me Talk Pretty One Day. 100 Greatest Essay. 4th ed. New York: Penguin Academics, 2008. Print.

Introduction To Human Development Sociology Essay

Introduction To Human Development Sociology Essay Human development describes the growth of humans throughout the life span, from birth to death. The scientific study of human development seeks to understand and explain how and why people change throughout life. What are the factors impacting on the wellbeing of the human? This includes all aspects of human growth, including physical, emotional, intellectual, social and personal development. Gowning up in environmental that is not safe, it is hard to survive. In this essay I will identify and discuss my own life experience and refer it to two theories of human development. Before concluding I will also discuss how these theories can be applied to social service practice. My own life experience I was born in Mogadishu the capital of Somalia. I have 5 sisters, I am in the middle three are older than and two is younger than me. I was born and grew up in an extended family including parents, grandparent, unties, uncles, cousins. We were lived in a villa house that was a family house. We were a middle class family where my father was the oldest among his brothers and sisters, his was a hardworking man and had very good job. My grandfather was working, and he was a mechanic he had his own garage. Some of uncles were working too and others were students. My mother was very nice person and she used to be home at all times to feed and take care of the children. We were a very happy family where my parents and grandparents worked together to bring the children up with love and affection. When the civil war broke out in Somalia 1991 and the central military government collapsed while the country became a field for the rebels who overthrow the military government to fight each other for power. Many families started leaving the country to save their lives leaving their house and other belongings behind. My family were not the first the people left the country, we remained inside our house because we thought that things will change and settle down would and the country will be a safe place to live. Unfortunately it kept getting worst, it was difficult for my family to be safe and survive because people were getting killed by rebels and due hunger because there was very little food and water. In 1994 my father was killed in the war and my grandfather decided to flee the country for the sake of our safety; we bagged up and left for the neighbouring Kenya. While we were on the way to Kenya there were a lot of strangers, who were caring guns, knives, and some other weapons. On the way to Kenya I witnessed dead bodies on the side of the road. At that time I was only 7 years old and I saw this massacre and I witnessed the people dying of hunger since I was 4 years old. When we arrived to Kenya, we met some our relatives that left the civil war who were already there. They helped us in finding the accommodation. I went to a school for first time in Kenya where I learnt mainly Islam Religion education, Somalia, Mathematics, and English. While staying in Kenya my uncles did not find work there was no work to survive and the living conditions were not good. In 2000 we moved to Ethiopia in search of better life and work during time many of my extended family members died. In 200 I came to New Zealand with my sisters and other family members including my grandfather, we arrived in Lower Hutt, Wellington and I enrolled High School. Theories Abraham Maslows theory Abraham Maslow developed the Hierarchy of Needs model in 1940-50s USA, and the Hierarchy of Needs theory remains valid today for understanding human motivation, management training, and personal development. Each of us is motivated by needs. Our most basic needs are inborn, having evolved over tens of thousands of years. Abraham Maslows Hierarchy of Needs helps to explain how these needs motivate us all. Maslows Hierarchy of Needs states that we must satisfy each need in turn, starting with the first, which deals with the most obvious needs for survival itself. Only when the lower order needs of physical and emotional well-being are satisfied we are concerned with the higher order needs of influence and personal development. Maslows hierarchy of needs 1. Biological and Physiological needs air, food, drink, shelter, warmth, sex, sleep, etc. 2. Safety needs protection from elements, security, order, law, limits, stability, etc. 3. Belongingness and Love needs work group, family, affection, relationships, etc. 4. Esteem needs self-esteem, achievement, mastery, independence, status, dominance, prestige, managerial responsibility, etc. 5. Self-Actualization needs realising personal potential, self-fulfillment, seeking personal growth and peak experiences. Relevance to my life experience Accordingly to Abraham Maslows theory the first need is food, water and shelter, after the civil was broke, family started form the first step of the triangle by searching Biological and Physiological needs. The second need was to be safe form difficult situation and survive. My father died in the war which was a huge impact on the safety of the whole family. We had to look for a safe place when the civil war broke out in Somalia and everything was destroyed. We have been to different countries to search better life for example we have been to Kenya, Ethiopia and finally New Zealand to live. My family settled in New Zealand because our two initial needs were met and we started working towards the third need. My sisters got married in here except two who has not got married and our family started growing. The fourth need was met by getting in to job and managing our day to day needs and work at home. Last year my grandfather passed away, he was 72. He reached at the fifth and last step of the triangle by actualizing his own self, he has been to Haj and became a spiritual leader in the community and he worked for the betterment of the community. Bronferbrenners Theory of Ecology Urie Bronferbrenners presented the theory of ecology on human development. This theory be made up of five systems, Microsystem, Mesosystem, Exosystem, Macrosystem and Chronosystem. These five systems influence the individuals growth and personality. Microsystem is where an individual lives; it includes parents, family and Whanau, peers, school and neighbourhood. Mesosystem explains about the relationship between Microsystem and the wider community, such as relation between family experience and school experience or church experience.  Ã‚  Exosystem explains about the influence of work and social environment and its impact on the family and personal values. Macrosystem is about the culture in which an individual lives and the choronosystem is about the patterning of events and transition over the life course and sociohistorical circumstances. Relevance to my life experience If I put myself in the centre of  a series of concentric circles of influence,  I can link the  theory of ecology to my growth and development. I  had my parents, my extended family and friends in my Microsystem circle where I learned to socialise. The structures of Somalian families are based on tradition values and beliefs where children are cared by the extended family and the eldest male is the head of the family. The influence of my Microsystem on my growth laid the foundation of my personality and behaviour. Mesosystem helped me to develop the sense of belongingness with the community and my culture, where I learned how to be culturally appropriate and respectful to the others in the community. Micro and Mesosystems are significant in the development of a child. During my childhood and growth the Choronsytem which overlapped the inner circles of influence, was very complex due to the struggle for the power and control. There was not government to keep people safe, the s urvival was the first priority for us. The sociohistorical circumstances of Somalia did not impact on me because I migrated to New Zealand and after my father passed away my grandfather continued passing on his beliefs in equality and human values in to my family and Somalian community. During my growth and development I internalised with my family and community and learned culturally appropriate activities and respectful relationship. This helped me to construct my personality and behaviour. How the theories may be applied and integrated into social service practice. Abraham Maslows five hierarchies need theories. Maslows best known influence to Humanistic psychology is his Hierarchy of Needs. Maslows Needs Hierarchy is often used to sum up the humanistic psychology faith system. The fundamental idea of his hierarchy is that everyone is born with specific essentials. If we do not meet those base needs, we are unable to survive and attention upward inside the hierarchy. In our social system and social services we need to identify the basic needs of the clients and once their initial needs are met than only it will be possible for a client to move to next step of the triangle. Once the need of shelter and food is met than a client can think of getting in to work-force or in relationship and care for his/her family and the children. We push further and further to excel in our careers, to expand our knowledge, and to constantly increase our self-esteem. After meeting all the needs we can be in a situation where we can help others to over-come their problems and feel satisfied by helping others. Bronferbrenners Theory of Ecology While working with client a social worker need to measure microsystem that including individuals family, peers, school and neighbourhood It is in the microsystem that the most direct interactions with social agents take place. . . (45, Santrock). It is important to assess the social system of a client while assessing clients situation. The circles of the ecology system impacts and influence the client and the client does not have any control over it. For example impact of a hard day at work place will impact on the home situation of a client. A child who did not have a good sleep last night due the party at home will be tired and behaving difficult at school. Therefore Bronferbrenners Theory of Ecology is used and integrated in social work practice to assess clients situation and particular behaviours. Conclusion In this essay I have written about my own life experience, which I really had a lot of challenging, moving out my own country to find better life and secure. It took while I and my family to recovered the problems that we have witnessed happening to our own families. There are many theories of human development that explains how the growth of a child is impacted by their environment and circumstances. I have linked two Human Development theories Bronferbrenners Theory of Ecology and Abraham Maslows theory of hierarchy of needs. Every human is shaped by his/her circumstances and situation. It is important to use and implement theories of human development to assess the clients situation by making sure their basic needs are met and how the overlapping circles of the ecology are impacting on the situation of the client.

math lesson Essay -- essays research papers

Lesson Plan Title: Alexander, Who Used to Be Rich Last Sunday: Understanding Opportunity Costs Grade Level:2, 3, or 6th Duration: three 50-minute class periods Student Goal: To understand that there is an opportunity cost to every economic decision and that these costs come as a result of limited resources. Student Objectives Students will: †¢ Identify "opportunity costs" in the story and in their own lives. †¢ Create an opportunity costs bar graph as a whole class. †¢ Complete a table of personal spending and savings information. †¢ Write an original story about how they spent and saved their allowance and what they gave up or their "opportunity costs" in order to reach their goals. Materials: †¢ a copy of Alexander, Who Used to Be Rich Last Sunday, by Judith Viorst †¢ chart paper †¢ markers †¢ overhead projector †¢ transparency †¢ student handout: How I Spent & Saved My Allowance (included). This was provided by the teacher in which I was doing my participant observations with. Set Up and Prepare: 1. Use the book Alexander, Who Used to Be Rich Last Sunday, by Judith Viorst. 2. Write the definition of the term "opportunity cost" on a sheet of chart paper and display for the class: Opportunity Cost: what you give up when you decide to do or buy something 3. Draw a bar graph on a transparency. Write the title "Opportunity Costs for a College Education" across the top. Label the horizontal axis "Opportunity Costs." Label the vertical axis "Number of Students." 4. Print out copies of the student handout "How I Spent & Saved My Money" for each student to take home. Directions: PART I: Step 1: Share with students a story about a time when you did not buy something you really wanted so that you could use or save the money for something more important. For example, maybe you didn't go on a vacation so you could save the money for a car you need to buy. Explain that what you gave up is called an "opportunity cost." Direct students' attention to the definition of "opportunity cost" displayed on the chart paper. Step 2: Ask students to share stories from their own lives in which they gave up something to get something else, or to save for something else that they want more. Have them identify their opportunity costs. Ask studen... ... †¢ How much does Alexander have after he buys the gum? ($0.85); after he loses a bet to his mother? ($0.70); after he rents Eddie's snake? ($0.58); after his father fines him for saying naughty words ($0.48); after flushing pennies down the toilet and dropping a nickel through a crack? ($0.40); after paying for Anthony's chocolate bar? ($0.29); after pennies disappear in Nick's trick ($0.25); after paying his father for kicking his brother? ($0.20); after buying things at a garage sale ($0.00). Set Up Shop/ Learning Center: Students set up a shop and role play the parts of customer and shopkeeper, making economic decisions along the way. Have them draw pictures or use manipulatives for the items they are selling in the store. Allow them to determine prices and tag each item. Then give all students the opportunity to be a customer and the shopkeeper. Provide customers with a limited amount of play money to spend in the store. They will need to budget their money so that they can afford all they need to buy. Using play money too, the shopkeepers sharpen their math skills as they make change for the customers. Assignments: Student Handout: How I Spent & Saved My Money

Integrating Anthropogenic Pollutants to Hard Red Wheat for Analysis of

Within the last century society’s reliance on petroleum and petroleum based products increased drastically. Currently the United States, the planet’s largest petroleum consumer, consumes twenty-five percent of the planet’s total petroleum, while only holding two percent of the natural resource (Banerjee, 2012). This has led to environmental catastrophes and cultural dependencies. Environmental catastrophes, which include the British Petroleum (BP) Deepwater Horizon Gulf spill, have demonstrated how a society dependent on petroleum can negatively affect the environment. Currently the Gulf is still undergoing heavy renovation to restore the once naturally rich environment. Oil spills, like the Deepwater Horizon, have led to growing concern about the chemicals society as a whole use and the effects they have on the environment. These catastrophes have led to hot topic debates, mainly due to the harmful anthropogenic pollutants entering the environment, which include global warming fresh water and soil quality. With these concerns arising, the need to protect the environment from anthropogenic pollutants entering the environment is in dire need. Anthropogenic pollutions can enter the soil directly or indirectly. This can originate from leaks, run-offs, mid-night dumping, improper discharge of chemical waste and a wide variety of other sources. Regulation to prevent pollution is in place by the Environmental Protection Agency (EPA) in the United States and the World Health Organization (WHO) in Europe. However, societies have become reliant on petroleum and petroleum based products, so the need to adapt and evolve becomes necessary in order to combat these pollutants. Adapting and evolving becomes a necessity if a society... ...cessed on March . 13, 2012. Banks K.M, and Schultz E. K. 2005. â€Å"Comparison of Plants for Germination Toxicity Test in Petroleum-Contaminated Soils.† Water, Air, and Soil Pollution 167: 211- 219. Dominguez-Rosado Elena, and John Pichtel. 2004. â€Å"Phytoremediation of Soil Contaminated with Used Motor Oil: II. Greenhouse Studies.† Environmental. Engineering Science 21:169-180. Gillian Adam, and Harry Duncan. 2002. â€Å"Influence of diesel fuel on seed .germination.† Environmental Pollution 120: 363.370. Scotts Miracle Gro. 2012. â€Å"Osmocote Potting Soil.† http://www.scotts.com/smg/catalog/productTemplate.jsp?proId=prod10650020&. itemId=cat10290002&tabs=general. Assessed on March 21, 2003. Tang Jingchun, Wang Min, Wang Fei, Qing Sun, and Qizing Zhou. 2011. â€Å"Eco-toxicity of petroleum hydrocarbon contaminated soil.† Journal of Environmental Science 23: 845-85.1.

Gene Therapy Essay -- Biology Medical Biomedical Genetics

Gene Therapy: The New Vaccine ABSTRACT This research paper details what gene therapy is and what it is (and potentially will be) used for. It also describes the gene therapy techniques and delivery methods that have been clinically tested and/or verified by scientists and the ideas that stimulate activity in the field in the race to perfect gene therapy methods and their application, as well as telling about the beginnings of its clinical testing and where this budding technology is headed. Finally, it discusses one last question: Is gene therapy the vaccination of the future? RESEARCH Gene therapy is a biotechnological technique that has recently made significant leaps of progress in the world of scientific research. The theories behind its use have created many new goals and ideas in scientists’ minds, and there is much opportunity for discovery in the field. There are two types of genetic technology that are currently being researched for application in clinical testing and for the cure of certain genetic diseases in humans: somatic cell gene therapy, and germ-line therapy. Somatic cell gene therapy is a development that could potentially eliminate a hereditary disease’s effects in a patient through the injection of genetic material that would fill in for a nonfunctional gene, alter an abnormal one in the patient’s chromosomes, or exchange the defective gene for a new, fully-functioning one (www.ornl.org). Germ-line therapy would be used similarly in embryos’ germ cells, but would have the additional effect of the faulty gene’s permanent eradication so that it could not be passed on to future descendants. There are also multiple types of somatic cell gene therapy. In vivo gene therapy, the most common in clinical testin... ...entists will make many revolutionary discoveries. With this new technology being researched, there’s no telling when the technology will be perfected. Who knows? Someday soon, gene therapy could even be something as commonplace as vaccination. Bibliography: 6 Friedmann, The Development of Human Gene Therapy http://www.ornl.gov/sci/techresources/Human_Genome/medicine/genetherapy.shtml http://www.accessexcellence.org/RC/AB/BA/Gene_Therapy_Overview.html http://asgt.org/news_releases/basics.html http://www.fda.gov/fdac/features/2000/500_gene.html http://www.cancer.gov/cancertopics/factsheet/Therapy/gene (G.T. for Cancer) http://content.nejm.org/cgi/content/short/346/16/1185 (Ex Vivo for X-SCID) http://asgt.org/news_releases/06022005a.html http://genome.gov/13014325 Reilly, Abraham Lincoln’s DNA and Other Adventures in Genetics Turksen, Adult Stem Cells 7

The Rise of Antibiotics

The Rise of Antibiotic-Resistant Infections by_ Ricki Lewis, Ph. D. _ When penicillin became widely available during the second world war, it was a medical miracle, rapidly vanquishing the biggest wartime killer–infected wounds. Discovered initially by a French medical student, Ernest Duchesne, in 1896, and then rediscovered by Scottish physician Alexander Fleming in 1928, the product of the soil mold Penicillium crippled many types of disease-causing bacteria. But just four years after drug companies began mass-producing penicillin in 1943, microbes began appearing that could resist it. The first bug to battle penicillin was Staphylococcus aureus. This bacterium is often a harmless passenger in the human body, but it can cause illness, such as pneumonia or toxic shock syndrome, when it overgrows or produces a toxin. In 1967, another type of penicillin-resistant pneumonia, caused by Streptococcus pneumoniae and called pneumococcus, surfaced in a remote village in Papua New Guinea. At about the same time, American military personnel in southeast Asia were acquiring penicillin-resistant gonorrhea from prostitutes. By 1976, when the soldiers had come home, they brought the new strain of gonorrhea with them, and physicians had to find new drugs to treat it. In 1983, a hospital-acquired intestinal infection caused by the bacterium Enterococcus faecium joined the list of bugs that outwit penicillin. Antibiotic resistance spreads fast. Between 1979 and 1987, for example, only 0. 02 percent of pneumococcus strains infecting a large number of patients surveyed by the national Centers for Disease Control and Prevention were penicillin-resistant. CDC's survey included 13 hospitals in 12 states. Today, 6. 6 percent of pneumococcus strains are resistant, according to a report in the June 15, 1994, Journal of the American Medical Association by Robert F. Breiman, M. D. , and colleagues at CDC. The agency also reports that in 1992, 13,300 hospital patients died of bacterial infections that were resistant to antibiotic treatment. Why has this happened? â€Å"There was complacency in the 1980s. The perception was that we had licked the bacterial infection problem. Drug companies weren't working on new agents. They were concentrating on other areas, such as viral infections,† says Michael Blum, M. D. , medical officer in the Food and Drug Administration's division of anti-infective drug products. â€Å"In the meantime, resistance increased to a number of commonly used antibiotics, possibly related to overuse of antibiotics. In the 1990s, we've come to a point for certain infections that we don't have agents available. † According to a report in the April 28, 1994, New England Journal of Medicine, researchers have identified bacteria in patient samples that resist all currently available antibiotic drugs. Survival of the Fittest The increased prevalence of antibiotic resistance is an outcome of evolution. Any population of organisms, bacteria included, naturally includes variants with unusual traits–in this case, the ability to withstand an antibiotic's attack on a microbe. When a person takes an antibiotic, the drug kills the defenseless bacteria, leaving behind–or â€Å"selecting,† in biological terms–those that can resist it. These renegade bacteria then multiply, increasing their numbers a millionfold in a day, becoming the predominant microorganism. The antibiotic does not technically cause the resistance, but allows it to happen by creating a situation where an already existing variant can flourish. â€Å"Whenever antibiotics are used, there is selective pressure for resistance to occur. It builds upon itself. More and more organisms develop resistance to more and more drugs,† says Joe Cranston, Ph. D. , director of the department of drug policy and standards at the American Medical Association in Chicago. A patient can develop a drug-resistant infection either by contracting a resistant bug to begin with, or by having a resistant microbe emerge in the body once antibiotic treatment begins. Drug-resistant infections increase risk of death, and are often associated with prolonged hospital stays, and sometimes complications. These might necessitate removing part of a ravaged lung, or replacing a damaged heart valve. Bacterial Weaponry Disease-causing microbes thwart antibiotics by interfering with their mechanism of action. For example, penicillin kills bacteria by attaching to their cell walls, then destroying a key part of the wall. The wall falls apart, and the bacterium dies. Resistant microbes, however, either alter their cell walls so penicillin can't bind or produce enzymes that dismantle the antibiotic. In another scenario, erythromycin attacks ribosomes, structures within a cell that enable it to make proteins. Resistant bacteria have slightly altered ribosomes to which the drug cannot bind. The ribosomal route is also how bacteria become resistant to the antibiotics tetracycline, streptomycin and gentamicin. How Antibiotic Resistance Happens Antibiotic resistance results from gene action. Bacteria acquire genes conferring resistance in any of three ways. In spontaneous DNA mutation, bacterial DNA (genetic material) may mutate (change) spontaneously (indicated by starburst). Drug-resistant tuberculosis arises this way. In a form of microbial sex called transformation, one bacterium may take up DNA from another bacterium. Pencillin-resistant gonorrhea results from transformation. Most frightening, however, is resistance acquired from a small circle of DNA called a plasmid, that can flit from one type of bacterium to another. A single plasmid can provide a slew of different resistances. In 1968, 12,500 people in Guatemala died in an epidemic of Shigella diarrhea. The microbe harbored a plasmid carrying resistances to four antibiotics! A Vicious Cycle: More Infections and Antibiotic Overuse Though bacterial antibiotic resistance is a natural phenomenon, societal factors also contribute to the problem. These factors include increased infection transmission, coupled with inappropriate antibiotic use. More people are contracting infections. Sinusitis among adults is on the rise, as are ear infections in children. A report by CDC's Linda F. McCaig and James M. Hughes, M. D. , in the Jan. 18, 1995, Journal of the American Medical Association, tracks antibiotic use in treating common illnesses. The report cites nearly 6 million antibiotic prescriptions for sinusitis in 1985, and nearly 13 million in 1992. Similarly, for middle ear infections, the numbers are 15 million prescriptions in 1985, and 23. 6 million in 1992. Causes for the increase in reported infections are diverse. Some studies correlate the doubling in doctor's office visits for ear infections for preschoolers between 1975 and 1990 to increased use of day-care facilities. Homelessness contributes to the spread of infection. Ironically, advances in modern medicine have made more people predisposed to infection. People on chemotherapy and transplant recipients taking drugs to suppress their immune function are at greater risk of infection. â€Å"There are the number of immunocompromised patients, who wouldn't have survived in earlier times,† says Cranston. â€Å"Radical procedures produce patients who are in difficult shape in the hospital, and are prone to nosocomial [hospital-acquired] infections. Also, the general aging of patients who live longer, get sicker, and die slower contributes to the problem,† he adds. Though some people clearly need to be treated with antibiotics, many experts are concerned about the inappropriate use of these powerful drugs. â€Å"Many consumers have an expectation that when they're ill, antibiotics are the answer. They put pressure on the physician to prescribe them. Most of the time the illness is viral, and antibiotics are not the answer. This large burden of antibiotics is certainly selecting resistant bacteria,† says Blum. Another much-publicized concern is use of antibiotics in livestock, where the drugs are used in well animals to prevent disease, and the animals are later slaughtered for food. â€Å"If an animal gets a bacterial infection, growth is slowed and it doesn't put on weight as fast,† says Joe Madden, Ph. D. , strategic manager of microbiology at FDA's Center for Food Safety and Applied Nutrition. In addition, antibiotics are sometimes administered at low levels in feed for long durations to increase the rate of weight gain and improve the efficiency of converting animal feed to units of animal production. FDA's Center for Veterinary Medicine limits the amount of antibiotic residue in poultry and other meats, and the U. S. Department of Agriculture monitors meats for drug residues. According to Margaret Miller, Ph. D. , deputy division director at the Center for Veterinary Medicine, the residue limits for antimicrobial animal drugs are set low enough to ensure that the residues themselves do not select resistant bacteria in (human) gut flora. FDA is investigating whether bacteria resistant to quinolone antibiotics can emerge in food animals and cause disease in humans. Although thorough cooking sharply reduces the likelihood of antibiotic-resistant bacteria surviving in a meat meal to infect a human, it could happen. Pathogens resistant to drugs other than fluoroquinolones have sporadically been reported to survive in a meat meal to infect a human. In 1983, for example, 18 people in four midwestern states developed multi-drug-resistant Salmonella food poisoning after eating beef from cows fed antibiotics. Eleven of the people were hospitalized, and one died. A study conducted by Alain Cometta, M. D. , and his colleagues at the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and reported in the April 28, 1994, New England Journal of Medicine, showed that increase in antibiotic resistance parallels increase in antibiotic use in humans. They examined a large group of cancer patients given antibiotics called fluoroquinolones to prevent infection. The patients' white blood cell counts were very low as a result of their cancer treatment, leaving them open to infection. Between 1983 and 1993, the percentage of such patients receiving antibiotics rose from 1. 4 to 45. During those years, the researchers isolated Escherichia coli bacteria annually from the patients, and tested the microbes for resistance to five types of fluoroquinolones. Between 1983 and 1990, all 92 E. coli strains tested were easily killed by the antibiotics. But from 1991 to 1993, 11 of 40 tested strains (28 percent) were resistant to all five drugs. Towards Solving the Problem Antibiotic resistance is inevitable, say scientists, but there are measures we can take to slow it. Efforts are under way on several fronts–improving infection control, developing new antibiotics, and using drugs more appropriately. Barbara E. Murray, M. D. , of the University of Texas Medical School at Houston writes in the April 28, 1994, New England Journal of Medicine that simple improvements in public health measures can go a long way towards preventing infection. Such approaches include more frequent hand washing by health-care workers, quick identification and isolation of patients with drug-resistant infections, and improving sewage systems and water purity in developing nations. Drug manufacturers are once again becoming interested in developing new antibiotics. These efforts have been spurred both by the appearance of new bacterial illnesses, such as Lyme disease and Legionnaire's disease, and resurgences of old foes, such as tuberculosis, due to drug resistance. FDA is doing all it can to speed development and availability of new antibiotic drugs. â€Å"We can't identify new agents–that's the job of the pharmaceutical industry. But once they have identified a promising new drug for resistant infections, what we can do is to meet with the company very early and help design the development plan and clinical trials,† says Blum. In addition, drugs in development can be used for patients with multi-drug-resistant infections on an â€Å"emergency IND (compassionate use)† basis, if the physician requests this of FDA, Blum adds. This is done for people with AIDS or cancer, for example. No one really has a good idea of the extent of antibiotic resistance, because it hasn't been monitored in a coordinated fashion. â€Å"Each hospital monitors its own resistance, but there is no good national system to test for antibiotic resistance,† says Blum. This may soon change. CDC is encouraging local health officials to track resistance data, and the World Health Organization has initiated a global computer database for physicians to report outbreaks of drug-resistant bacterial infections. Experts agree that antibiotics should be restricted to patients who can truly benefit from them–that is, people with bacterial infections. Already this is being done in the hospital setting, where the routine use of antibiotics to prevent infection in certain surgical patients is being reexamined. We have known since way back in the antibiotic era that these drugs have been used inappropriately in surgical prophylaxis [preventing infections in surgical patients]. But there is more success [in limiting antibiotic use] in hospital settings, where guidelines are established, than in the more typical outpatient settings,† says Cranston. Murray points out an example of antibiotic prophylaxis in the outpatient setting–children with recurrent ear infections given extended antibiotic prescriptions to prevent future infections. (See â€Å"Protecting Little Pitchers' Ears† in the December 1994 FDA Consumer. Another problem with antibiotic use is that patients often stop taking the drug too soon, because symptoms improve. However, this merely encourages resistant microbes to proliferate. The infection returns a few weeks later, and this time a different drug must be used to treat it. Targeting TB Stephen Weis and colleagues at the University of North Texas Health Science Center in Fort Worth reported in the April 28, 1994, New England Journal of Medicine on research they conducted in Tarrant County, Texas, that vividly illustrates how helping patients to take the full course of their medication can actually lower resistance rates. The subject–tuberculosis. TB is an infection that has experienced spectacular ups and downs. Drugs were developed to treat it, complacency set in that it was beaten, and the disease resurged because patients stopped their medication too soon and infected others. Today, one in seven new TB cases is resistant to the two drugs most commonly used to treat it (isoniazid and rifampin), and 5 percent of these patients die. In the Texas study, 407 patients from 1980 to 1986 were allowed to take their medication on their own. From 1986 until the end of 1992, 581 patients were closely followed, with nurses observing them take their pills. By the end of the study, the relapse rate–which reflects antibiotic resistance–fell from 20. 9 to 5. 5 percent. This trend is especially significant, the researchers note, because it occurred as risk factors for spreading TB–including AIDS, intravenous drug use, and homelessness–were increasing. The conclusion: Resistance can be slowed if patients take medications correctly. Narrowing the Spectrum Appropriate prescribing also means that physicians use â€Å"narrow spectrum† antibiotics–those that target only a few bacterial types–whenever possible, so that resistances can be restricted. The only national survey of antibiotic prescribing practices of office physicians, conducted by the National Center for Health Statistics, finds that the number of prescriptions has not risen appreciably from 1980 to 1992, but there has been a shift to using costlier, broader spectrum agents. This prescribing trend heightens the resistance problem, write McCaig and Hughes, because more diverse bacteria are being exposed to antibiotics. One way FDA can help physicians choose narrower spectrum antibiotics is to ensure that labeling keeps up with evolving bacterial resistances. Blum hopes that the surveillance information on emerging antibiotic resistances from CDC will enable FDA to require that product labels be updated with the most current surveillance information. Many of us have come to take antibiotics for granted. A child develops strep throat or an ear infection, and soon a bottle of â€Å"pink medicine† makes everything better. An adult suffers a sinus headache, and antibiotic pills quickly control it. But infections can and do still kill. Because of a complex combination of factors, serious infections may be on the rise. While awaiting the next â€Å"wonder drug,† we must appreciate, and use correctly, the ones that we already have. {draw:rect} Big Difference If this bacterium could be shown four times bigger, it would be the right relative size to the virus beneath it. Both are microscopic and are shown many times larger than life. ) Although bacteria are single-celled organisms, viruses are far simpler, consisting of one type of biochemical (a nucleic acid, such as DNA or RNA) wrapped in another (protein). Most biologists do not consider viruses to be living things, but instead, infectious particles. Antibiotic drugs attack bacteria, not viruses. {draw:rect} *The Greatest Fe ar–Vancomycin* Resistance When microbes began resisting penicillin, medical researchers fought back with chemical cousins, such as methicillin and oxacillin. By 1953, the antibiotic armamentarium included chloramphenicol, neomycin, terramycin, tetracycline, and cephalosporins. But today, researchers fear that we may be nearing an end to the seemingly endless flow of antimicrobial drugs. At the center of current concern is the antibiotic vancomycin, which for many infections is literally the drug of â€Å"last resort,† says Michael Blum, M. D. , medical officer in FDA's division of anti-infective drug products. Some hospital-acquired staph infections are resistant to all antibiotics except vancomycin. Now vancomycin resistance has turned up in another common hospital bug, enterococcus. And since bacteria swap resistance genes like teenagers swap T-shirts, it is only a matter of time, many microbiologists believe, until vancomycin-resistant staph infections appear. â€Å"Staph aureus may pick up vancomycin resistance from enterococci, which are found in the normal human gut,† says Madden. And the speed with which vancomycin resistance has spread through enterococci has prompted researchers to use the word â€Å"crisis† when discussing the possibility of vancomycin-resistant staph. Vancomycin-resistant enterococci were first reported in England and France in 1987, and appeared in one New York City hospital in 1989. By 1991, 38 hospitals in the United States reported the bug. By 1993, 14 percent of patients with enterococcus in intensive-care units in some hospitals had vancomycin-resistant strains, a 20-fold increase from 1987. A frightening report came in 1992, when a British researcher observed a transfer of a vancomycin-resistant gene from enterococcus to Staph aureus in the laboratory. Alarmed, the researcher immediately destroyed the bacteria. Ricki_ Lewis is a geneticist and textbook author. _ {draw:rect} FDA Consumer magazine (September 1995)