copitam.icu

Hemophilia
Case

A 24-year-old white man has a diagnosis of hemophilia at the age of about 5 to 6 years. He has recently visited the hematology clinic for the follow-up after hospitalization for an accidental knife cut that caused excessive bleeding. The patient has a history of excessive bleeding from tooth extraction, excessive bruising since childhood and the upper gastrointestinal bleeding in the past three years. He has reported chronic pain of his joints and ankles and denied hemarthroses. The patient has given reports about the episodes of excessive bleeding treatment by use of factor VIII and fresh frozen plasma (Remor, 2013).

The patient has the FVIII deficiency (hemophilia A) which is a common type of hemophilia that affects about 5, 000 males at births. The disease approximately affects about 25, 000 people in the United States. Individuals with hemophilia suffer from deficiencies in clotting factor. The mild hemophilia bleedings problems do mainly occur after surgery, trauma and injury. The condition can accompany some symptoms. Almost 25% of the population with hemophilia has the mild deficiency. Those with moderate hemophilia experience bleeding episodes after minor injuries and may lead to spontaneous episodes of bleeding. The server hemophilia happens after trauma, injury and surgery. It has the spontaneous bleeding into muscles and joints characteristics. Recurrent bleeding of the joints also known as hemarthrosis causes hemophilic arthropathy that causes disability at a very young age (Department of Genetics 2015).

Causes

Hemophilia is a disease happening as a result of gene mutation, and it is a genetic disease. About 70% of hemophilia cases are inheritable from parents. However, the other 30% of patients do not have the family history. In such cases, the main cause of the condition is by a spontaneous gene mutation during the fertilization stage. Hemophilia is also a condition that is linked to sex since the FIX and FVIII geneses are found on the X chromosome. It is the chromosome X that determines the gender of the baby. Thus, the condition’s clinical manifestation has a link to sex. Therefore, females may not express the bleeding symptom like the males (McPhee, & Hammer, 2012).

Pathophysiology
The main source of factor VIII (FVIII) production is thought to be from the reticuloendothelial and the liver system. Transplantation of the liver can correct FVIII deficiency to persons with hemophilia. It is because of the increasing cases of individuals with mild hemophilia having progressive liver diseases. Thus, it is an indication that the liver is the main site for FVIII synthesis (Cayir, Yavuzer, and Sayli, 2014).

The RNA messenger for FVIII is also detectable in spleen and liver among other issues. Studies indicate that the production of FVIII in cells lines that are transferable show that after synthesis the FVIII shifts to the endoplasmic reticulum lumen. It is then within other protection that functions in regulating secretion. It particularly regulates the immunoglobulin binding protein in which it has to dissociate in a process that depends on energy. The FVIII’s signal peptide cleavage, as well as oligosaccharides, also takes place in the endoplasmic reticulum. The calnexin, chaperone proteins, and calreticulin, enhance both FVIII degradation and secretion. Regarding genes, the location of the FVIII (F8C) is at the X chromosome arm at Xq28 region. This gene becomes large comprising of 25 intones and 26 exons. A mature FVIII will have about 2332 amino acids. FVIII deficiency is as a result of gene inversion that causes disrupt to the FVIII gene. The disruptions are insertions, point mutations, and deletions. The low levels of FVIII happen as results of external FVIII gene defects (Huether, &McCance, 2012).

Executive Summary
The ICS project provides the solution to the Waste, Water and the Sewage systems through the provision of remote and local control of the movement of the turbulence of the liquid and aqueous solutions. The ICS system incorporates the combination of different integrated systems that control pressure regulates the speed as well as controlling the gate valves in water catchment areas. The ICS system implements the SCADA technology to take the digital management and control of the wastewater and the sewage. The SCADA technology applies the sensor approach methodology whereby the sensor mechanism gets involved in managing and controlling the intake and the pumps used at the various points in the industrial system. The gadgets controlled include the water pumps the distributors and the purifying centers. The SCADA automates the process of the water supply to enhance proportional distribution of water in industries, factories, urban centers, rural areas, the domestic utilization and the agricultural operations like irrigation. The ICS-SCADA system gets applied in the Waste and Sewage system control and disposal. The SCADA systems monitor the discrete data and information concerning the entry of the waste material within the conduit pipes. The applications of the SCADA in the ICS include the pressure hydraulic pumps utilized in the boreholes gas and oil distributing industries.

ICS Industry Architecture Being Designed
The ICS system shall incorporate the utilization of the hardware and the software integration of materials and components. The structure and the design of the ICS-SCADA system shall include the user interface architectural design, the backend and the front end operation interface. The ICS-SCADA systems architecture incorporates the relational and the non-relational database design. The design of the ICS-SCADA control and management structure shall implement the three tires and the two tire client-server based systems to ensure multiple computer-based operations. The system hardware and software components include the dedicated Remote Terminal Units (RTU) and the Radio Telemetry Units for running and controlling the control algorithms for the flow control (Brodsky, & Radvanovsky, 2011). The architecture also incorporates the input and the output systems for the displaying of the graphics, charts and diagrams for the monitored and analyzed values. The video display monitors and the telnet oriented video conferencing system shall get embedded in different terminals to enhance the remote and local troubleshooting and diagnosing of the entire system. The ICS-SCADA system shall incorporate the electromagnetic field sensors for the detection of flaws and dangers imposed within the system to relay the alarms and notifications to end users. The system architecture shall incorporate the installation of the storage devices interlinked with the data and information repository backup systems. The storage system shall implement the VMware cloud computing system to facilitate the storage of data and information for the future decision making. The ICS-SCADA system architecture shall take into consideration the installation and embedding of the artificial intelligent systems to enhance big data analysis as well as data mining and data warehousing for the waste, water, and the sewage control.

1. Overview

The SCADA project shall implement the Redundant Fiber Optic and the Ethernet network. The system shall use the Node system of linking the World Wide Web interface. The proposed SCADA system within the Waste, Water and the Sewage system shall involve the replacement of the Unix SCADA systems with the improved redundant SCADA systems. The project team shall design a comprehensive system that incorporates the mesh network topology. The network topology shall link over 5000 data points using the SCADA System and connect the complete installation and integration of the control systems (Brodsky, & Radvanovsky, 2011).

2. Statement of Need
The government and the water treatment center shall provide the solution to the general public industries and the agricultural sectors through the installation of the water treatment points and plants in different stages. The current problem of impure water requires the application of the sewers and the pump stations in the water treatment and catchment areas. The solution on the waste dumping and flow require the installation of the waste and water treatment plant at various points of water flow. The sewage control and management problem require the implementation of the ICS-SCADA sludge treatment plant in the urban and the industrial areas (Pramod, et al…, 2013). The various treatment points require monitoring of flow turbulence to regulate the speed and pressure of the materials on the transit network.

3. Detailed Description
The ICS-SCADA system shall incorporate the operational interfaces that gather and conduct the entire system control at the various routes and the section of the interface. The operational strategies shall incorporate the implementation of the SCADA Human Machine Interface (HMI) (Dzung, et al…, 2005). The system shall get embedded to the network terminals and the links to facilitate easier reading and interpretation of data and information. The system shall apply the simplified user capabilities over the entire system that guarantee operational and implementation friendly.

ICS Network Architecture
The main physical and logical devices implemented in the ICS-SCADA system involve the processors, the controllers, and the RTU’s. The entire system shall incorporate the connection of the devices via the neutral fiber optic and the Ethernet network. The processing unit shall manage and control the input and the output materials within the SCADA systems. The controllers shall include the Programmable Logic Control (PLC) responsible for automation of observing and analyzing of data and information (IEEE Guide for the Commissioning of Electrical Systems in Hydroelectric Power Plants, 1998). PLC allows easy programming of different applications. The Physical Control Systems (PCS) controls the movement of materials by regulating the speed and pressure. The Remote Terminal Units (RTU’s) have the responsibility for facilitating synchronization between pumps and the sensor mechanisms. The RTU’s adjusts the data and information according to the analysis within the system.

Committing suicide do happen in different scenarios whereby one can voluntarily decide to take a way life without the knowledge of the relatives. On the other hand, some seek advice and support on how to take away their life. This controversial has got the attention of law such that some states have established rules and regulations to govern the action of assisted suicide. In basic legal regulations, it is necessary to understand the role played by involved party played in committing the suicide. It has been taken as illegal in a handful of states for physician-assisted suicide whereby over 30 states have taken the step of enacting the statutes of prohibiting assisted suicide. They have well arguably prohibited assisted suicide through the common law.

According to the U.S. Supreme Court, there is no an actual constitutional right to die. This saw the court leaving for individual state to enact its legislation of permitting or prohibiting physician assisted suicide. The fact is that a person will be guilty of taking part in a suicide attempt when the individual knowingly causes or helps the person to attempt the suicide. However, through the Death with Dignity Act, ill adults have the option of seeking for lethal doses from osteopathic physicians for them to have a peaceful ending of life.

Besides the assisted suicide having some support and eligibility from some states, there are some legal issues that arise over the practice. The fact is that the roles played by legislators, judges and administrative officials in influence the patient care do vary. The legal issue that will raise the eyebrows is that if assisted suicide is made legal, then the follow up experience will be the ending of lives without the consent of the people through the human negligence and abuse of the law. Legalization of the assisted suicide will have the high number in compromising of the family as well as the intergenerational commitments. The legal issue that will follow out is the controversial about the delivery of human equality and dignity before the state law (Cassel, 7). It, therefore, comes with some concerns with the consideration of assisted suicide as legal.

The assisted suicide comes with ethical concern such that the doctors are defined with eh role of doing no harm. How ideal is it for the doctor to facilitate the ending of life. However, the law sees differently such that old aged human have right to die with dignity and peaceful and this can get done with the assistance of doctors. It sounds moral, right and caring for a compassionate medical practitioner to provide patient with necessary prescription that will enable the patient to die with dignity. This is not such controversial to the principle that is paramount that states that doctors have the duty of relieving suffering. It actually depends with the state law since participation in suicide is taken as murder unless the ending of life is done professionally as defined by the common law. Otherwise, prosecution should take its direction.

Assisted suicide may come up on a genuine basis although at times remain to have some hidden meaning. The issue of assisted suicide should be taken within the given range and it should get considered only acceptable within a given scope of execution. It is ethical to observe the rights of the human and the respecting of other opinions that seems to reduce suffering to their lives. Thus, assisted suicide should only be legal under special circumstances.