Sample Paper: Pathology Report

Sample Paper: Pathology Report: Bronchopulmonary Dysplasia

Introduction to the Pathology 

Bronchopulmonary dysplasia (BPD) is an illness that affects the lungs of newborns. The disease has higher prevalence rates in premature newborns. BPD affects how the breathing of newborns, making them require oxygen therapy. The oxygen is given through a breathing tube, a mask, and nasal prongs (National Heart, Lung, and Blood Institute, n.d.). Proper gas exchange occurs when there is an increased lung surface area with an expanded number of blood vessels, an increased number of alveoli, and a thin alveolar-capillary barrier. The surface area of the lung increases at the later stages of lung development. These are the saccular and alveolar stages. This stage of lung development is interrupted in patients with BPD. This then leads to an ineffective respiratory system that cannot achieve gas exchange. Respiratory support is therefore needed to enable gas exchange. Advances in neonatal and perinatal care of preterm infants have changed the pathology of BPD. Treatments such as gentle ventilation, postnatal surfactant, and antenatal steroids have changed how BPD affects infants. The classic pathology of BPD was characterized by hypertensive remodeling of the pulmonary arteries, extensive alveolar septal fibrosis marked airway smooth muscle hyperplasia, and squamous metaplasia. The new pathology is characterized by mild airway smooth muscle thickening, reduced dysmorphic vascular bed with rare epithelial lesions, and a simplified alveolar structure (Thekkeveedu, Guaman & Shivanna, 2017).

Etiology of the Pathology 

Antenatal factors contribute to the disease. These factors include genetic susceptibility. Twin studies demonstrate that genetics contribute to BPD. The occurrence of moderate to severe BPD is higher in identical twins as compared with non-identical twins. Candidate genes that contribute to the BPD have also been identified using a genome-wide association study. Population-based studies, however, do not demonstrate the relationship between genomic loci with moderate to severe BPD. These findings demonstrate that BPD is caused by multiple genes and pathways. Intrauterine growth restriction (IUGR) also contributes to the disease.  It is hypothesized that biological mechanisms that lead to IUGR can also contribute to restricted fetal lung growth. These factors include vascular endothelial growth factor (VEGF), VEGF receptor and placental dysfunction, and deficiency of insulin growth factor. Chorioamnionitis also contributes to BPD. This condition occurs due to the inflammation of the membranes that surround the fetus (amnion and chorion) due to a bacterial infection. Pregnancy-induced hypertensive disorders also contribute to the condition. Pregnancy-induced hypertensive disorders include eclampsia, preeclampsia, and gestational hypertension. These disorders cause an imbalance between pro and anti-angiogenetic mediators, which then leads to decreased angiogenesis. This then interrupts lung development. Maternal smoking also contributes to the condition. Studies have consistently demonstrated that maternal smoking increases the incidence of preterm birth and complications related to preterm birth, such as BPD. Cigarette smoke disrupts normal lung development and function through dysregulated angiogenesis, altered alveolar type II cell metabolism, placental dysfunction, and epigenetic changes (Thekkeveedu, Guaman & Shivanna, 2017).

Natal factors also contribute to BPD. These factors include premature birth and low birth weight, which are the strongest risk factors for BPD. Preterm birth contributes to BPD due to functional immaturity. It also contributes to the disease due to routine life-saving interventions such as mechanical ventilation and oxygen supplementation that are used on preterm birth infants. These interventions injure the lungs and may interrupt lung development (Thekkeveedu, Guaman & Shivanna, 2017).

Postnatal factors also contribute to the condition. These factors include oxidative stress and hyperoxia. The risk of oxidative stress is high in premature infants due to exposure to free iron, increased susceptibility to infection and inflammation, and immature antioxidant defenses. Oxidative stress then causes a disruption of lung development. The mechanisms that take place during the interrupted lung development are vasculogenesis, apoptosis, cell proliferation extracellular matrix assembly, and disruption of growth factor signaling. Another contributor to BPD is sepsis. Studies show an increased risk of BPD in postnatal sepsis. Sepsis affects lung development by causing endothelial injury in the lungs, oxidative stress, and inflammation. Patent ductus arteriosus (PDA) also contributes to BPD.  The ductus arteriosus is usually present in fetuses where it shunts blood from the pulmonary artery to the aorta so as to avoid the high resistance of the non-functioning lungs. The ductus arteriosus closes a few days of birth; however, in some patients, the ductus arteriosus does not close leading to PDA. PDA is common in low birth weight patients and worsens lung injury. Respiratory microbial dysbiosis also contributes to BPD. Dysbiosis refers to an imbalance of the complex microbial communities inside the body or on the body. The microbial colonization of the human respiratory tract starts in utero or shortly after birth. Bacterial diversity can be decreased by bowel colonization, method of feeding, mode of delivery, antibiotic exposure, chorioamnionitis. These changes increase the microbial colonization in the lungs, which may then lead to inflammatory lung phenotype, which then plays a key role to the development of BPD (Thekkeveedu, Guaman & Shivanna, 2017).

Clinical Features 

The signs of BPD include premature newborns requiring oxygen therapy after reaching 36 weeks of gestation. Another sign is feeding problems. This leads to delayed growth. Another sign is pulmonary hypertension which is caused by increased pressure in the pulmonary artery. Cor palmonale also occurs in patients with BPD. This condition is characterized by failure in the right-hand side of the heart. This condition occurs when the blood pressure on the pulmonary artery and the lower right chamber of the heart is high (National Heart, Lung, and Blood Institute, n.d.).

Diagnostic Procedures 

The diagnostic procedures include the evaluation of the blood gas. The condition affects the breathing of the patient, and blood gas can reveal the existence of the disease. The examination of blood gas may reveal acidosis, hypercarbia, and hypoxia, all of which demonstrate BPD. The diagnosis also involves chest radiographs. This test shows decreased lung volumes, pulmonary interstitial emphysema, pulmonary edema, area of atelectasis, and hyperinflation. Diagnosis also involves using an echocardiogram. This device is used to examine pulmonary hypertension. The diagnosis of the disease done using postmenstrual age. Oxygen requirement at 36 weeks postmenstrual age signifies BPD. Differential diagnoses that should be examined include pulmonary interstitial emphysema, tracheomalacia, pulmonary hypertension, pneumonia, and pulmonary atelectasis (Sahni & Mowes, 2020).

Treatment 

Treatment strategies include preventing the development of BPD. This includes prenatal prevention. Prenatal prevention focuses on preventing premature birth. This happens by surgical closure of the cervix with cerclage, maternal progesterone supplementation, reducing the risk of multiple pregnancies by avoiding fertility treatment when several follicles are potentially available for ovulation, and encouraging pregnant women to avoid smoking.

Postnatal prevention involves ventilation. Avoiding lung overinflation and high tidal volumes is essential. This can be achieved by permissive hypercapnia with a partial pressure of carbon dioxide in the arterial blood (PaCO2) from 45 mmHg to 55 mmHg and a pH greater than 7.20. Intubation should also be reduced as much as possible. Non-invasive respiratory ventilation procedures are also encouraged. They include high flow nasal cannulas (HFNCs), nasal continuous positive airway pressure (NCPAP), and non-invasive positive pressure ventilation (NIPPV). Another preventive strategy is oxygen supplementation. In the first few minutes of life, the SpO2 should be 70% to 80%. After 5 minutes, the SpO2 should be maintained from 88% to 92%, with an alarm limit of 96%. The preventive treatments also include surfactant administration. Surfactant reduces preterm mortality and can be used to modify the mechanisms that contribute to BPD. Another preventive treatment is glucocorticosteroid administration. This reduces the risk of BPD in ventilated preterm patients. Caffeine is also a preventive treatment strategy. Caffeine reduces the risk of BPD development. This could happen due to the anti-inflammatory properties of caffeine which may reduce the pathogenic mechanisms of BPD. Vitamin A treatment can also be used to prevent the development of BPD. Vitamin A is important to the integrity and development of the respiratory tract. The supplementation of vitamin A might therefore reduce the risk of BPD. Nitric oxide is also a treatment to prevent the development of BPD. It has been found effective in treating term neonates with persistent pulmonary hypertension and hypoxemic respiratory failure. Another treatment is cell therapy. Exogenous stem or progenitor cells can be used to regenerate or protect a damaged lung (Principi, Di Pietro & Esposito, 2018).

Sample Paper: Critical Book Review

Sample Paper: Critical Book Review: Alister McGrath, “The Intellectual Origins of the European Reformation”

McGrath’s expansive volume delves into an extensive field of the historiological analysis of the intellectual origins of the Reformation with an antidote of the contribution of the scholastic and the humanist movements. Written from the perspective of a reflective debate, the author presents four critical thematic tropes in the book, which capture the Reformation as a critical development and historical epoch. McGrath delves into the precedents of the Reformation in the medieval era, the contribution of renaissance perspectives, the anomalies persistently found in the reformation scholasticism and the influence of theological schisms of the late medieval period on the Reformation. Ideological developments are hard to pin down to single events or episodes. Therefore, McGrath asserts a great deal of effort in demonstrating the causes of the Reformation as an evolutionary process. In essence, McGrath indicates that the formation was the natural culmination of creative efforts, local and cosmopolitan interactions, academic and social forces working seamlessly to challenge the institutionalized theological development of society as a whole.

            The book is divided into two parts, and part one delves into the intellectual context of the reformation era. The historical origins of lay religion and the crisis of authority within the institutions of the Roman Catholic Church are treated to an exhaustive analysis. The section analyses the development and influence of humanism and reformation as central ideological influences capturing the popular religious conscience of both clergy and intellectuals within university establishments. Ideological developments in the late medieval era are demonstrated to have immensely influenced the debate about changes in theological styles and practice within divergent spheres of influence. The second part deals with the sources and methods of the exertion of reformist operations within the steamed altercations that ensued.

The translation of scripture and traditional approaches to the same are demonstrated to have slightly showed discrepancies which reformers found faulty. The clash between divergent schools of thought of scholasticism, hermeneutics, and humanism took the ideological stimulation a notch higher. Moreover, the critical discrepancy in the reception of Augustine made a clear divergence between the various branches of the church and their followers. In the last part, the author takes a close look at the intellectual and ideological heterogeneity that characterized the early Reformation and concludes that an amorphous interaction of intellectually stimulated tropes of ideals with haphazard discontinuities characterized the rise of the Reformation.

McGrath captures in detail the astonishing diversity of late medieval thought and the ideological clash of the era that produced reformation agitations in diverse locations. The author follows closely the works of Joseph Lortz, who also delved into the contributions of medieval Augustinianism, humanism, and nominalism as critical influences. He further acknowledges the influence of humanism in the propagation of Lutheran theology, which had a central role in the entire process of Reformation. Even the famous central principle “sola scriptura” never could achieve any value without an explicit scheme for the interpretation of the scripture. The two wings of the Reformation, Lutheranism (Wittenberg) and Reformed (Calvin, Bucer, and Zwingli) the author argues, had had very distinct origins and perpetuated diverse cases against the traditional medieval practices of the church which later formed the foundation of the Reformation.

The author demonstrates that both Luther and Karlstadt as university theologians only achieved establishing a new theology but never really found a reform program in its entirety. However, the scholastic theses set precedence the justification of the desirability of critical changes following the developments achieved earlier through the works of St. Augustine and new scriptural interpretations of the era. The book continues to attract intellectual interest not only through its early years. Still, it will remain relevant for many years to come for its lucidity and accurate interpretations of historiological developments of the era.

Bibliography

Alister McGrath, The Intellectual Origins of the European Reformation. Oxford, Blackwell,         2004.

Ozment, Steven. The Age of Reform, 1250-1550: An Intellectual and Religious History of Late    Medieval and Reformation Europe. Yale University Press, 2020.

Wallace, Peter George. The long European Reformation: Religion, political conflict, and the        search for conformity, 1350-1750. Red Globe Press, 2020.

Sample Paper: Critical Appraisal

Sample Paper: Critical Appraisal of Sue Breakell’s “Perspectives: Negotiating the Archive”

Perspectives: Negotiating the Archive

            Archival work has captured the imagination of many in the fields of history, and the arts as a central reference point of primary documentation. Still, the private notes, memoirs, and works of great historians and artists have been gathered to compose useful autobiographical archives that complement their public productions. The work of archivist and curators, as well as those whose journals are documented, has overlapped much recently. Many artists and historians have even resorted to cooperating with museums and other archival institutions to construct their content in a given manner for the advancement of particular individual interests. Breakell has advanced the view that futuristic archival work and curators of original documents have grown to depart considerably from traditional notions. The fundamental tenets of archival theory like authenticity have been traversed by new concepts of continuity, complexity, and ambiguity, which have been witnessed recently.

            Archival work represented a mode of practice and connection to an artist or place, but all these tenets have gained much fluidity because of sweeping changes in society. As it were, where there were authority and power, now it is only ambiguity, complexity, and fragmentation of notions once cherished. The relationships between artists, archivists and researchers have advanced to a considerable fluidity in which all parties no longer have clear distinctions of their roles and expectations. Still, they only forge what is meaningful and valuable for their concerns. The author is of the views that within the scope of the fluid encounter in archival work, the historiography of new epochs and practices have emerged that must be understood as admissible in practice. Archival work manifests immense contradictions and discontinuities that depict it as a territory of exploration and of works that only embody journeys of discovery.

The complexity and ambiguity that is witnessed in archival work is that time and distance have become rapidly paced and meaning transitory. Whereas archival work tends to preserve constancy, researchers’ interactions with content only embody fluidity, which, therefore, influence the altruism of archival undertaking. Tracing any authenticity between the present and future presentations is a defeated conclusion. Researchers are therefore called upon to bear a particular competency that should be constructive for their work. The authors have tried to embed diverse discourses in the varied segments of archival work from meaning to value and purpose, which leads to the conclusion that archives have metamorphosed as much as society has advanced beyond chaos and complexity. From the vantage point of her professional accomplishments, the article is rich with insights and directives that should inform futuristic archival work in its varied, complex facets.

The archive has gone through diverse metamorphoses, and the works of varied researchers and interests in archival work embed diverse complexities. While the traditional notions of the archive as a static store of documents have shifted, contemporary practices should evolve at the same rate. The author cautions the readers from the use of meaning, and the interpretation of archival works in the traditional sense and suggests that a hybrid outlook is necessary. The article is rich with immense references to critical appraisals and examples from varied scholars making the same conclusion. Breakell has made an astounding contribution to the body of work, seeking a better understanding of archival work in a rapidly changing field. The author suggests that a collaborative approach is what is needed in mitigating the inherent flaws in theory and practices regarding archival work within the scope of the new paradigms characterized by change and complexity.

US Immigration Policy Shapers

US Immigration Policy Shapers

What are the assumptions and factors that seem most important in shaping immigration policy at different times in US history, and how accurately have they reflected US national interests from your perspective? National interests would presumably include both which immigrants are most desirable at a given time, as well as a desire to avoid the negative consequences associated with some immigrants.

While you should certainly mention specific immigration policies as a way to discuss assumptions, factors, and interests, you are not expected to comprehensively cover all US immigration policies.

Policing in Texas

Policing in Texas

Do you think Texas police officers, prosecutors or judges who have participated in wrongful arrests and prosecutions should be subject to being incarcerated for no less than six months in county jail or perhaps even one to two years in state prison — if their participation in such wrongful arrests and prosecutions was proven to be knowing and intentional?

Should those Texas police officers, prosecutors or judges who have participated in such wrongful arrests and prosecutions automatically lose their property and money in a civil lawsuit to that individual where it is proven that the wrongful arrest and conviction was knowing and intentional? In such a circumstance, should the state of Texas also be subjected to having to compensate the individual wrongfully arrested and convicted at the rate of $3 million dollars (or more) for every year lost by the individual to imprisonment?