Combination Adjuvant Platform for Human and Animal Vaccines

Combination Adjuvant Platform for Human and Animal Vaccines A novel combination adjuvant platform for human and animal vaccines   Ravendra Garg, Sylvia van Drunen Littel-van den Hurk Volker and Gerdts Abstract Adjuvants are critical component of vaccines. They are being used to enhance and extend the overall immune response, to drive the response towards a specific type of immunity, and to reduce the need for multiple booster immunizations. Here we report the development of a combination adjuvant platform consisting of three immune stimulators, namely host defence peptides, polyphosphazenes and PolyI:C/CpG ODN. The adjuvant platform was co-formulated with a variety of human and animal vaccines and tested in mice, pigs, sheep, koalas, and fish. When co-formulated with a wide range of viral and bacterial antigens including Bordetella pertussis, Respiratory Syncytial Virus (RSV), Chlamydia trachomatis and influenza antigens, a single immunization induced 100-1,000 fold stronger humoral immune responses (IgG, IgG1, IgG2a), a much earlier onset of immunity, a clear shift towards a more balanced or Th-1 type of response and extended duration of immunity of up to two years in some cases. The vacc ines were highly effective in neonates of less than 7 days of age and provided complete protection against a lethal challenge with B. pertussis or RSV. Furthermore, the polyphosphazenes in this combination allow the assembly of microparticles that when lyophilized were stable for several months. Intranasal immunization with these microparticles induced strong mucosal immune response in the upper respiratory tract. Moreover, the adjuvant platform was highly effective in the presence of maternal antibodies. In summary, we developed a novel vaccine platform for neonates, which provided more balanced, long lasting and fully protective immune responses in neonates after a single vaccination only. Introduction Vaccine provides huge public health benefits for reducing the burden of infectious diseases. Live vaccines generate effective immune responses but have been associated with a number of safety concerns, including improper attenuation and reverting back to virulence.   Nonliving vaccine antigens i.e. whole, inactivated viruses and specifically recombinant or highly purified subunit vaccines are often weakly immunogenic and need adjuvants to enhance the immunogenicity of vaccine based on antibodies and effector T cell functions to prevent infection. Adjuvants are critical components of vaccines, usually used to stimulate faster, stronger, and long-lasting immune responses to vaccines. It has various roles in vaccine formulations i.e. enhance immune responses to vaccine antigens, provide faster onset of immunity, improving immune responses to immunization in infant or elderly populations, whose immune system are immature or waning, dose sparing, either reducing the quantity of antigen required in the vaccine preparation or reducing the immunization schedule (Coffman, Sher et al. 2010). Adjuvants are absolutely required in subunit vaccines due to the poor immunogenicity of such antigens. There is no single universal adjuvant which can cover all the vaccine requirements. Using single adjuvant has a number of limitations, including induction of weak, improper, and short lived immune responses. For example, alum and MF59 (Kenney and Edelman 2003) are the universally approved adjuvant for human vaccines. Both normally induce a Th2 biased immune responses but not cellular immune responses which required for immunity against intracellular infections. In many novel adjuvant technologies, using multiple adjuvants in combination often act synergistically by stimulating and activating a various type of immune cells. Combination of adjuvants platform is promising and beneficial for suboptimal vaccines and particularly advantageous for vaccines against specific and more susceptible populations, such as neonates and the older adults. In some aspects, the neonate immune system is similar to that of the elderly, both having diminished anti-microbial activity by immune cells, reduce d antigen uptake and presentation by antigen presenting cells and compromised adaptive immune responses (Simon, Hollander et al. 2015). Strong adjuvants may provide an approach to boost immune responses in the both neonates and elderly populations. Most of the studies have combined a delivery system with an immunostimulatory adjuvant, especially combinations with the TLR agonists and MPL. Combination adjuvants have only recently been vigorously explored. Some combinations have been tested in humans and large animals and have yielded promising results. Recently, we developed a novel combination adjuvant platform (TriAdj) which is highly effective with wide range of animal and human vaccine. Novel Combination adjuvant platform for animal vaccines: Veterinary vaccines have been used for several of years, and have an important role in protecting animal health, animal welfare, food production, and public health. They are a cost-effective method to prevent animal disease, improve the food production, greatly reducing the need for antibiotics to treat food and companion animals and reduce or prevent transmission of zoonotic disease to human. Interestingly, the challenges related with vaccinating animals are stability, low cost, ease of administration etc., require new solutions in vaccine development. Freund introduced a combination of mineral oils and bacterial cell components (Freunds complete adjuvant) for the improvement of vaccine immune responses (Freund et al., 1937). However, many nations are not using the Freunds adjuvant in animals due to its reactivity and side effects. Alum and emulsions based formulations have been successfully used since long time in a wide variety of animal vaccines. However, with an advanced underst anding of the immune system, many new adjuvants (Saponins, Liposomes, virosomes, particle based and TRL ligand) have recently been developed for veterinary applications. A wide range of adjuvants has been successfully used in commercial vaccines for animals and several new technologies are currently in preclinical development. Over the past decade, we have seen several new combination adjuvants, typically contain two and three individual adjuvant components, including MF59â„ ¢ (Novartis Inc.), ASâ„ ¢ (Glaxo Smith Kline Inc.), IC31â„ ¢ (Valneva Inc.) etc. We recently developed a novel combination adjuvant platform (TriAdj) that is contained of three components, namely toll-like receptor (TLR) agonist either PolyI:C or CpG ODN and an immunostimulatory host defense peptide (HDPs) in polyphosphazene carrier system (Kindrachuk, Jenssen et al. 2009; Garg, Latimer et al. 2013). Synthetic PolyI:C and CpG ODNs are well known potent adjuvant with various vaccine antigens and have been shown to enhance immune responses by activating monocytes/macrophages, dendritic cells, natural killer cells and B cells, and induce the production of proinflammatory cytokines   (Krieg 2002; Trumpfheller, Longhi et al. 2012). The second component, HDPs are derivatives of natural host defense peptides, which are cationic amp hipathic peptides with microbicidal, chemotactic and/or immunomodulatory properties (Yeung, Gellatly et al. 2011). HDPs are involved in a range of immune functions including immune cell recruitment (neutrophils, monocytes, macrophages, T cells and mast cells), innate immune activation, and wound healing (Jenssen, Hamill et al. 2006). The third component, polyphosphazenes are synthetic water-soluble biodegradable polymer with immunostimulatory properties, and forms non-covalent complexes with variety of viral and bacterial antigens and/or other adjuvants to enhance their stability, immunogenicity and allow multimeric presentation (Mutwiri, Benjamin et al. 2007; Andrianov, DeCollibus et al. 2009; Kovacs-Nolan, Latimer et al. 2009; Awate, Wilson et al. 2012). When vaccine antigens were co-formulated with this combination, we found much faster onset of immunity, highly effective even after a single immunization and significantly long lasting, robust, protective immune responses against variety of animal pathogens including bovine viral diarrhea virus, bovine respiratory syncytial virus and porcine epidemic diarrhea virus. The combination adjuvant is stable, cost effective and highly effective in a variety of animals including pigs, sheep, cattle, koalas, cotton rats and mice (Polewicz, Gracia et al. 2011; Khan, Waugh et al. 2014; Snider, Garg et al. 2014; Garg, Latimer et al. 2015). For example, formulation of E2 protein of bovine viral diarrhea virus with TriAdj resulted in strong humoral and cell mediated immune responses, leading to significant protection following pathogen challenge of calves (Snider, Garg et al. 2014). Fusion protein of bovine respiratory syncytial virus co-formulated with TriAdj developed significantly higher antibod ies and interferon gamma secretion (Kovacs-Nolan, Mapletoft et al. 2009). Similarly, formulation of S1 domain of porcine epidemic diarrhea virus, and outer membrane protein of chlamydial major   with TriAdj enhanced humoral and cell mediated immune response in pig and koalas respectively (Khan, Waugh et al. 2014; Makadiya, Brownlie et al. 2016). Novel Combination adjuvant platform for human vaccines: Several combination adjuvants consisting of a variety of immunomodulators such as Immune stimulating complexes (ISCOMs), montanides, nanoemulsions, and Adjuvant Systems have been developed in recent years and are currently being tested with human vaccines in preclinical and clinical trials. The novel adjuvant platform, TriAdj was co-formulated with various human vaccines and tested in mice, pigs, sheep, koalas, and fish. This adjuvant platform is highly effective against a variety of infectious diseases. TriAdj was shown to promote the induction of strong immune responses to various viral and bacterial antigens in multiple animals. For instance, TriAdj in combination with fusion protein of human respiratory syncytial virus (hRSV), mediated the induction of robust, balanced and long-term protective immunity by stimulating long-lived neutralizing antibodies, memory B and CD8+ T cells against hRSV (Garg, Latimer et al. 2013; Garg, Latimer et al. 2014). In addition, mucosal vaccination with TriAdj formulated antigen induced both systemic and local immunity in neonates, even in the face of maternal antibodies (Garg, Latimer et al. 2015). Similarly, when TriAdj was used with pertussis toxoid of Bordetella pertussis, strong and protective immune responses were found in both mice and pigs against lethal infection with B. pertussis (Gracia, Polewicz et al. 2011; Polewicz, Gracia et al. 2011). Furthermore, the vaccine formulated with TriAdj induced a prompt onset, longer duration than existing commercial vaccines and effective after a single vaccination even in the presence of maternal antibodies. (Polewicz, Gracia et al. 2013). TriAdj platform was also formulated with influenza virus antigens or chlamydia antigens, which induces strong immune responses in vaccinated animals (Kindrachuk, Jenssen et al. 2009; Shim, Ko et al. 2010). The combination of adjuvants was also shown to be suitable for maternal immunization. Vaccination of pregnant animals with TriAdj formulated human vaccines resulted in efficient transfer of maternal antibodies and protection from subsequent challenge of the offspring (Elahi, Buchanan et al. 2006; Garg, Latimer et al. 2016). These results indicate that maternal immunization with TriAdj formulated antigens might be an alternative, safe and effective approach to provide protection against pathogens in newborn and young infants. Furthermore, the adjuvant platform can be formulated into microspheres (100 nm to 2 ÃŽ ¼m) to enhance the mucosal and syt emic immune response following intranasal vaccination (Garlapati, Garg et al. 2012). The TriAdj is expected to have multiple applications for the development of vaccines against multiple respiratory pathogens and possibly other infectious agents. Mechanisms of action of novel Combination adjuvant platform: A number of mechanisms of action were identified for this novel combination adjuvant. For example, TriAdj as a mucosal adjuvant increased antigen uptake by dendritic cells, improved dendritic cell maturation, and more efficient transported to local draining lymph nodes to present the antigen to T cells   (Garg, Latimer et al. 2013). TriAdj with antigens promoted the production of chemokines, cytokines and inflammatory cytokines, followed by recruitment and activation of several immune cell populations including dendritic cells, macrophages and neutrophils to the upper and lower respiratory tract, that leads to strong and long-term   protective immune responses of this novel adjuvant formulation (Sarkar, Garg et al. 2016). This was further correlated to the induction of local humoral and cell-mediated immune responses, including production of large numbers of IgA secreting memory B cells as well as effective memory CD8+ T cells. TriAdj also promoted increased germinal centre react ions and effective B cell activation and development in the lungs following mucosal immunization (Garg, Theaker et al. 2016). References   Andrianov, A. K., D. P. DeCollibus, et al. (2009). Poly[di(carboxylatophenoxy)phosphazene] is a potent adjuvant for intradermal immunization. Proc Natl Acad Sci U S A 106(45): 18936-18941. Awate, S., H. L. Wilson, et al. (2012). Activation of adjuvant core response genes by the novel adjuvant PCEP. Molecular immunology 51(3-4): 292-303. Coffman, R. L., A. Sher, et al. (2010). Vaccine adjuvants: putting innate immunity to work. Immunity 33(4): 492-503. Elahi, S., R. M. Buchanan, et al. (2006). Maternal immunity provides protection against pertussis in newborn piglets. Infect Immun 74(5): 2619-2627. Garg, R., L. Latimer, et al. (2014). Vaccination with the RSV fusion protein formulated with a combination adjuvant induces long-lasting protective immunity. J Gen Virol 95(Pt 5): 1043-1054. Garg, R., L. Latimer, et al. (2015). The respiratory syncytial virus fusion protein formulated with a novel combination adjuvant induces balanced immune responses in lambs with maternal antibodies. Vaccine. Garg, R., L. Latimer, et al. (2013). Induction of mucosal immunity and protection by intranasal immunisation with a novel respiratory syncytial virus vaccine formulation. The Journal of general virology. Garg, R., L. Latimer, et al. (2016). Maternal immunization with respiratory syncytial virus fusion protein formulated with a novel combination adjuvant provides protection from RSV in newborn lambs. Vaccine 34(2): 261-269. Garg, R., M. Theaker, et al. (2016). A single intranasal immunization with a subunit vaccine formulation induces higher mucosal IgA production than live respiratory syncytial virus. Virology 499: 288-297. Garlapati, S., R. Garg, et al. (2012). Enhanced immune responses and protection by vaccination with respiratory syncytial virus fusion protein formulated with CpG oligodeoxynucleotide and innate defense regulator peptide in polyphosphazene microparticles. Vaccine 30(35): 5206-5214. Gracia, A., M. Polewicz, et al. (2011). Antibody responses in adult and neonatal BALB/c mice to immunization with novel Bordetella pertussis vaccine formulations. Vaccine 29(8): 1595-1604. Jenssen, H., P. Hamill, et al. (2006). Peptide antimicrobial agents. Clinical microbiology reviews 19(3): 491-511. Kenney, R. T. and R. Edelman (2003). Survey of human-use adjuvants. Expert review of vaccines 2(2): 167-188. Khan, S. A., C. Waugh, et al. (2014). Vaccination of koalas (Phascolarctos cinereus) with a recombinant chlamydial major outer membrane protein adjuvanted with poly I:C, a host defense peptide and polyphosphazine, elicits strong and long lasting cellular and humoral immune responses. Vaccine 32(44): 5781-5786. Kindrachuk, J., H. Jenssen, et al. (2009). A novel vaccine adjuvant comprised of a synthetic innate defence regulator peptide and CpG oligonucleotide links innate and adaptive immunity. Vaccine 27(34): 4662-4671. Kovacs-Nolan, J., L. Latimer, et al. (2009). The novel adjuvant combination of CpG ODN, indolicidin and polyphosphazene induces potent antibody- and cell-mediated immune responses in mice. Vaccine 27(14): 2055-2064. Kovacs-Nolan, J., J. W. Mapletoft, et al. (2009). Formulation of bovine respiratory syncytial virus fusion protein with CpG oligodeoxynucleotide, cationic host defence peptide and polyphosphazene enhances humoral and cellular responses and induces a protective type 1 immune response in mice. The Journal of general virology 90(Pt 8): 1892-1905. Krieg, A. M. (2002). CpG motifs in bacterial DNA and their immune effects. Annu Rev Immunol 20: 709-760. Makadiya, N., R. Brownlie, et al. (2016). S1 domain of the porcine epidemic diarrhea virus spike protein as a vaccine antigen. Virol J 13: 57. Mutwiri, G., P. Benjamin, et al. (2007). Poly[di(sodium carboxylatoethylphenoxy)phosphazene] (PCEP) is a potent enhancer of mixed Th1/Th2 immune responses in mice immunized with influenza virus antigens. Vaccine 25(7): 1204-1213. Polewicz, M., A. Gracia, et al. (2011). Influence of maternal antibodies on active pertussis toxoid immunization of neonatal mice and piglets. Vaccine 29(44): 7718-7726. Polewicz, M., A. Gracia, et al. (2013). Novel vaccine formulations against pertussis offer earlier onset of immunity and provide protection in the presence of maternal antibodies. Vaccine 31(31): 3148-3155. Sarkar, I., R. Garg, et al. (2016). Formulation of the respiratory syncytial virus fusion protein with a polymer-based combination adjuvant promotes transient and local innate immune responses and leads to improved adaptive immunity. Vaccine 34(42): 5114-5124. Shim, D. H., H. J. Ko, et al. (2010). Efficacy of poly[di(sodium carboxylatophenoxy)phosphazene] (PCPP) as mucosal adjuvant to induce protective immunity against respiratory pathogens. Vaccine 28(11): 2311-2317. Simon, A. K., G. A. Hollander, et al. (2015). Evolution of the immune system in humans from infancy to old age. Proc Biol Sci 282(1821): 20143085. Snider, M., R. Garg, et al. (2014). The bovine viral diarrhea virus E2 protein formulated with a novel adjuvant induces strong, balanced immune responses and provides protection from viral challenge in cattle. Vaccine 32(50): 6758-6764. Trumpfheller, C., M. P. Longhi, et al. (2012). Dendritic cell-targeted protein vaccines: a novel approach to induce T-cell immunity. Journal of Internal Medicine 271(2): 183-192. Yeung, A., S. Gellatly, et al. (2011). Multifunctional cationic host defence peptides and their clinical applications. Cellular and Molecular Life Sciences: 1-16.

Government Subsidies to Correct Externalities Essay -- Alternative Ene

Government Subsidies to Correct Externalities The provision of energy is riddled with market failures. For instance, the U.S. maintains a military presence in the Middle East at least partly in order to secure energy supplies, but to what extent do U.S. consumers pay for that at the pump? Anecdotally, petrol costs about half in the States what it does in Europe. For another example, short haul flights are often cheaper than train tickets to the same destination, and yet, air travel is about ten times worse for the environment than is rail. Does the cost of either ticket account for this difference? Both the production and consumption of energy give rise to economic costs that are difficult to allocate. These externalities are a long-recognized economic problem. That is why we are in the midst of boom times for the alternative energy industry. For the most part, alternative means alternative to derivatives of crude oil, but it also seeks to substitute for coal and to a lesser extent nuclear energy. In many cases, demand for alternatives has exceeded supply. Similarly, demand for investments in new alternative energy technologies has exceeded the stock of available good ideas (Green Dreams, 2006). But has this driven up the price? Well, sort of. What has happened is governments around the world have stepped in to support alternative energy. According to The Economist magazine, 49 governments have made formal commitments. So while consumers by and large are still minimizing cost in the energy purchases, their elected governments have demanded dramatic changes in patterns of production (Investing in clean energy, 2006). There are broadly three reasons for consumer preference for alternative energy.... ... to assure that society gets the package of output that it desires. Works Cited The answer, my friend? ? Can the windy Great Plains be a new power source, or is that just bluster? (2006, October 26). The Economist. Green Dreams ? The flood of money into clean energy is better news for society than it is for investors. (2006, November 16). The Economist. Investing in clean energy ? Tilting at windmills. (2006, November 16). The Economist. Hammond, P., Gamble, B. (2006, February 16). Simmons Oil Monthly ? Solar Energy Overview. Retrieved 17 November 2006 from: http://www.simmonsco-intl.com Campbell, J. (2005, February 12). NOPA Biodiesel Speech. National Oilseed Processors Association 2005 Annual Meeting. Wind Power. Wikipedia. Retrieved 17 November 2006 from: http://en.wikipedia.org/wiki/Wind_energy

Organizational Change Plan Essay

Electronic Health Record or EHR, is an electronic record of patient health information that includes demographics, progress notes, medications, vital signs, past medical history, and any other pertinent data that relates to a patient’s health record (â€Å"Himss†, 2012-2013). Electronic Health Records make clinical workflow more effective and efficient as well as provides monetary incentives from Medicare and Medicaid for those organizations that implement the use of these electronic records. CPOE, also known as Computerized Physician Order Entry, is a system utilized by physicians to enter in patient orders electronically. It is a safer and more effective way for doctors to enter orders for their patients and by using it, an organization will receive monetary benefits from Medicare and Medicaid. Change is important to any organization in order for that business to keep up with its competitors and to increase as well as improve the products and services that it provides to its customers. Technology plays a big role in the changes of an organization because technology is becoming more and more of a means of communication; whether it be in the form of communicating with cell phones to a physician communicating what orders he wants for a patient by using CPOE. The organization that I work for is in need of implementing Computerized Physician Order Entry in order to attest to and meet the requirements for Stage 2 for Meaningful Use. The Centers for Medicare & Medicaid Services has an EHR Incentive program that provides organizations monetary incentives for meeting certain requirements through the use of electronic health records. Their Meaningful Use requirements are split up into stages and in order to meet Stage 2, organizations have to implement certain requirements with the first being to use Computerized Physician Order Entry (Woodcock, 2010). Organizational and individual barriers such as lack of involvement from employees, lack of communication, fear and stress can cause issues when it comes to implementing a change such as CPOE. According to Barriers To Change (2007), â€Å"Involving employees as soon as possible in the change process and letting them create as much of the change as possible, is key to a successful change effort. â€Å" The organization that I work for has tried to involve the physicians in the building process of CPOE from the beginning. We have asked their input on what order sets would be good for them to have to make ordering easier and have let them practice in the Meditech Test environment by entering orders on fake patients; we have gotten really good feedback from the doctors that chose to come and it has helped with the change process. Inadequate communication is often the reason behind barriers to change and people being receptive to the change. Many people in the hospital did not know what CPOE was; communicating with them from the beginning about the system and what it actually is may have helped with the introduction of the system to the organization. Our hospital goes LIVE with CPOE September 24, 2013 and although administration was asked many months prior to this to inform the hospital of what was coming, most employees knew nothing about it until they came to the training classes that were held to show them how orders would be entered when we went up with CPOE. When it comes to change, certain details need to be shared with employees because they need to know why this change is occurring, what this change means for the organization itself, and what the change means for them and how it will affect their job(s). People often fear change, especially if they are not a part of it or aware of it. If employees understand why the change is occurring then they are more likely to accept it. CPOE can be a big change for an organization and can cause fear. Explain to employees what CPOE is, how it will improve patient safety in terms of legibility, and how it will create a better workflow for physicians and staff. According to Borkowski (2005), stress can certainly be increased due to change; it can create a physical as well as a psychological response in the work force. CPOE can put a lot of stress on physicians and supporting staff because their whole workflow has to change; learning a new routine of working needs encouragement and support from everyone. Factors that may influence the change could include content issues, process issues, contextual issues, and individual differences. Content issues are specific to each organization and refer to the change that is being implemented, in this case CPOE. These content issues can occur in an attempt to meet demands such as government regulations or changes in technological demands (â€Å"Factors Influencing Organizational Change Efforts,† n.d., p. 762). In the case of the organization that I work for they are implementing CPOE in order to meet the demands of Meaningful Use Stage 2 government requirements. Process issues are the actions that are taken during the implementation of the change and involve open, honest communication with employees about the change (â€Å"Factors Influencing Organizational Change Efforts,† n.d., p. 762). The organization should be honest with its employees about what CPOE is and why it is needed or why it will be a good change for the organization. They should also be efficient and express confidence that the change will be successful; knowing that administration is behind the change is an important part of being confident and showing employees that the organization is ready for this change (â€Å"Factors Influencing Organizational Change Efforts,† n.d., p. 763). Contextual issues deals with external factors that usually can’t be changed and internal factors that can be. External factors would include government regulations, as stated before, meeting Meaningful Use Stage 2 requirements. Internal factors would be attitudes or feelings about the change, lack of resources, or lack of knowledge about technology. If attitudes are negative coming from administration then employees are going to have a negative attitude towards the change as well. Administration or those implementing the change need to have a positive attitude and positive outlook on CPOE and express to employees that CPOE is going to improve workflow as well as patient safety when it comes to order entry. According to Factors Influencing Organizational Change Efforts (n.d.) organizations have a variety of individuals who have different attitudes and personalities that could influence the reaction and commitment to change. Individual differences can have a big impact on the implementation and the acceptance of CPOE; attitudes need to be positive and encouraging and communication needs to be open in order to have successful implementation of computerized physician order entry. Factors influencing organizational readiness mainly come from individuals themselves who are not ready or who do not want to accept the change. Individual readiness for change is when someone is open and willing to change; if the person is not open or willing then this affects their readiness for change. It seems as though the physicians are the ones who are the least ready for the change from paper charting to CPOE. Physicians are used to writing orders on paper, giving verbal orders or giving telephone orders and with CPOE this all changes. CPOE requires physicians to do their own ordering so verbal and telephone orders are supposed to be used as little as possible. Their readiness to change from ordering on paper to electronic ordering is not very high because they like the flexibility of being able to tell nurses to place orders for them and with CPOE this process is supposed to stop. Kurt Lewin’s change model of unfreezing, change and refreezing relates to the proposed change from placing orders on paper to electronic order entry. Unfreezing is an important step in the change process because it deals with communicating to employees about the change. Inform staff what CPOE is, why the hospital is making the change to CPOE and what CPOE means for the employees. Change deals with making the actual change from physicians ordering on paper to placing their own orders electronically. The refreezing stage is when the change has been implemented and accepted; the change has been accepted and the effects of the change are being monitored (Borkowski, 2005). Resources for the implementation of CPOE involved internal as well as external persons. Training will include superusers who will be available to assist staff on the units when the change is made. The Clinical Informatics team will be available extra hours to provide coverage on the CPOE Go Live day. Our facility uses Meditech so there will be Meditech consultants that come to assist us with the Go Live preparation of CPOE. Our physicians and nurses will have the coverage and help that they need with the implementation of Computerized Physician Order Entry. Resources Borkowski, N. (2005). Organizational Behavior in Health Care. Retrieved from The University of Phoenix eBook Collection database. Factors Influencing Organizational Change Efforts. (n.d.). Journal of Organizational Change Management, 20(6), 761-773. Retrieved from http://www.emeraldinsight.com.ezproxy.apollolibrary.com/journals.htm?articleid=1630997&show=abstract HiMSS. (2012-2013). Retrieved from http://www.himss.org/library/ehr/?navItemNumber=13261 Woodcock, E. (2010, September). . , 31(9), 91-92. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/757065487

The Sudan Genocide - 749 Words

Sudan Genocide The Sudan genocide started on the 26 February 2003, When the Sudan liberation movement rebel groups took up arms against the government of Sudan, the Sudan government responded to the attacks by arming the Janjaweed militia’s and started an ethnic cleansing against non-Arabism Darfur leaving hundreds of thousands dead. At the beginning of 1991 non-Arabs of the zaghawa complained that they were victims of the intensifying Arab apartheid campaign. Sudanese Arabs who control the government are widely referred to as practicing apartheid against non-Arab citizens. The government is accused of â€Å"cleverly manipulating Arab solidarity to carry out policies of cleansing out an ethnic group. The genocide began on the 26th of February and a group called the Darfur liberation front and claimed that they attacked Golo. Army outposts and police stations were attacked by the rebels and the government took action by performing massive air and land assaults on the rebels. 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In the largest country in Africa, it is unimaginable that a genocide conducted by their government continues while the rest of the world does nothing. The largest country in Africa is Sudan, which is located on the northeastern side of Africa. The western region of Sudan is the primary focus, Darfur. This regionRead MoreForeign Influence and Its Positive and Negative Impacts1285 Words   |  5 Pagesfighting and hatred. The majority of people believe that there isnt a specific cause for genocide. However – as shown by the Sudanese and Rwandan Genocides—foreign influence, and the absen ce of it, plays a big role in causing genocide. Before exmaning the effects of foriegn influence in causing genocide, it is important to understand the concepts of foreign influence and genocide. The UN defines genocide any of the following acts committed with intent to destroy, in whole or in part, a nationalRead MoreGenocide in Darfur Essay1531 Words   |  7 PagesHolocaust of Today: Genocide in Darfur By definition, genocide is â€Å"the deliberate and systematic extermination of a national, racial, political, or cultural group.† According to Eric Reeves, writer for the Sudan Tribune, genocide â€Å"encompasses not only the killing of members of a national, ethical, racial, or religious group, as such, but also deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or part.† Whatever genocide may be definedRead MoreGenocide in Darfur Essay1479 Words   |  6 PagesIn recent times, the media has highlighted the genocide that has been occurring in Darfur, Sudan. Darfur, Sudan is a country roughly the size of the state of Texas (Darfur Scores, n.d.). Genocide is the systematic killing of an entire ethnic group of people from a national, ethnic, or religious group, or an attempt to do away with them all (Darfur Scores, n.d.). Beginning around 2003, according to Darfur Scores (n.d.), â€Å"the Sudanese gover nment in Khartoum and the government-sponsored Janjaweed militiaRead MoreThe Conflict in Darfur and United States Involvement877 Words   |  4 Pagesregion of Sudan known as Darfur. These fights have been taking place since 2003 and have continued to today. Similarities can be made to the Rwandan Genocide; there is a government funded and armed militia that is not officially supported by the government that is killing a local population. The citizens of the region of Darfur that are being killed are not Arabic, like the majority of the rest of Sudan is, however, they are more similar in culture and other aspects to the citizens of South Sudan, Sudan’s