Facilitating Change in Health and Social Care Management

Facilitating Change in Health and Social Care Management Summary There needs to be a summary of the major points, conclusions, and recommendations. It needs to be short as it is a general overview of the report. Some people will read the summary and only skim the report, so make sure you include all the relevant information. It would be best to write this last so you will include everything, even the points that might be added at the last minute. Normally it start with past tense Introduction According to Kotter (1999), change management is a set of principles, techniques, and prescriptions embed to the human aspects of executing major change initiatives in organisational settings. It is strategic tool deploy by management to re-direct the use of resources, business process, budget allocations, or other modes of operation that radically reshape a company. The focus of this report is on Beacon Edge Care Home(BECH), a care home that provides support and care for 33 people with Dementia. An inspection was conducted on 21th and 22th of November 2016, and on the 13 of December 2016 unannounced by the Care Quality Commission (CQC) and the outcome of the inspection indicated that Beacon Edge Care Home has not made any improvement based on the recommendations of the first inspection conducted by CQC and the home does not have a registered manager on duty at the time of the inspection.   Regulatory body later found out that BECH does not even have a registered manager as stipula ted under Health and Social Care Act 2008 (Edwards, 2013). The Act indicated that it is mandatory that registered providers of care have a registered persons. A Registered person have legal responsibility for meeting the requirements under Health and Social Care Act 2008 and has the necessary qualifications, competence, skills and experience to supervise the management of the regulated activity (CQC, 2017). The researcher of this report will be the new manager of BECH and will be responsible for implementing change within the organisation.   The manager will need to identify and make required changes before the next inspection by CQC According to Kotter (1999), to implement change in an organisation, the firm have to understand their environment, their strengths and weaknesses and identify areas of improvement that could lead to change management. Hence, to gain a clearer of pictures of the problems facing Beacon Edge Care Home, the researcher will need to conduct a PEST analysis to identify the strength and weakness and areas of improveme nt of BECH. The key factors that can bring change in Beacon Edge Care Home management is be by conducting identifying the strength, weaknesses, areas of improvement as well as turning weaknesses to opportunities. The PEST Analysis and SWOT Analysis will be deployed as factors that can drive change in Beacon Edge Care Home. A PEST analysis is an analysis of the external macro-environment that affects all firms. It helps organisation to determine how political, economic, social and technology can impact the performance and activities of an organisation in the long-term (Daft, 2011). Political Factors Beacon Edge Care Home would assess the political factors affecting its organisation for failing to comply with regulatory bodies like Care Quality Commission. In the report, CQC indicated that their recommendations from the first visit was not implemented and BECH violated   health and safety Act 1974 by not having adequate   care plans and risk assessments to meet the individual needs of people who used their service   and medicines given to service users were poorly managed, hence people are placed at risk of not receiving their medicines as prescribed (Devorshak, 2012).BECH breaches different regulations in the BECH for not   providing adequate care for their service users. Person centred approach was not notable during the CQC visit, there was lack of good governance and staffing, servicers were given the wrong medicine and local health and social care professionals were concerned about the inconsistent of management team in the home. For the new manager to facilitate cha nge in the organisation, all regulatory bodies and environmental issues will need to evaluated and change to meet the needs of the service users. Economic Factors Beacon Edge Care Home should review their employment policies and ensure that it is in compliance with health and Social care requirement of employing candidate that have the right skill set needed in the establishment (Devorshak, 2012). The report indicated that service rendered by BECH to their clients was not adequate and staff lack the understanding and the requirements of the Mental Capacity Act 2005. Training and development strategy will need to be deployed by the new manager to continually improve the skill of the workforce. Social Factors The manager of Beacon Edge Care Home would need to conduct critical evaluation how the organisation meet the needs of the patients Beacon Edge Care Home. The gap in service delivery will enable the manager to understand the areas that need immediate change (Devorshak, 2012). The CQC report indicated that employees of the organisation have no idea how to meet the cultural and social needs of the patients Technology The new manager of Beacon Edge Care Home should investigate how technology can enhance the delivery of quality service to their patients. This can be conducted by looking at current quality cycle of the service provided and factor areas that will be easier to implement with the introduction of technology. SWOT Analysis SWOT Analysis (Strengths, Weaknesses, Opportunities and Threats) is a strategic tool used by organisations to understand their strengths and weaknesses, and to identify their opportunities and threats (Rego and Nunes, 2010).Strengths and weaknesses analysis the internal structure of the organisation, while opportunities and threats generally relate to external factor that the business do have control of (Rego and Nunes, 2010).The researcher will focus on the internal structure of the Beacon Edge Care Home by looking at the strengths and weaknesses. Strengths The strength of Beacon Edge Care Home is the staff. People that were spoken during the inspection indicated that the staff were very caring, pleasant and helpful. Patients were comfortable with the staff as well as they find them very friendly helpful. Further, visitor to the home also indicated that the staff were excellent. The management is blessed with good staff. However, the management lack leadership and do not follow the regulatory bodies criteria especially noncompliance with Health and Social Care Act 2008. Weaknesses Beacon Edge Care Home lack leadership. CQC report on the inspection of BECH indicated that the care and service provided by the organisation is not fit for purpose. Confidential information is not kept secured and did not meet the requirements of the Data Protection Act 1998. There are catalogues of regulation breaches and there is was no registered person on the premises during the time of the inspection that can help the organisation to meet the requirement of different regulatory bodies. The two major weaknesses   are lack of leadership and skilled workers that understand the requirement of Data protection, Act, Health and Safety Act 1974 and the Mental Capacity Act 2005. The new managers will need to evaluate the weaknesses of the organisations such noncompliance with regulations bodies, lack of leadership and lack of training for the employees in order to implement changes in the organisation. The home has good and dedicated staff, Beacon Edge Care Home can tap into by providing leadership, firstly getting a registered person on board and providing training and development for existing staff as well as employing staff with key skills to fill the gaps identified. Opportunities The new managers can help to turn things around in the organisation. There is opportunity to recruit and train existing staff on different requirements associated with health and social care The report by CQC on BECH highlighted most of issues the company need to resolve and this   presents the opportunity for BECH to implement these changes in order to improve their rating   health and social care rating,  Ã‚   customers satisfaction, staff satisfaction and other stakeholders 1.2 The challenges that key factors of change bring to health and social care services Business organisations are faced with different challenges. The health and social care organisations are not immune from these challenges as well. The critical evaluation of the Care Quality Commission report on Beacon Edge Care Home clearly shows that the organisation is faced with various challenges such as: Lack of management support Financial resources Equipment Lack of leadership, Training and development for employee Shortage of staff with key skills, Maintaining quality Effective use of resources Noncompliance with different regulatory bodies. Lack of communication and coordination To implement change, Beacon Edge Care Home must address these issues. 1.2.1 Lack of leadership The CQS report on the home shows that the organisation lack leadership. Daft (2011) describe leadership as individual that have the ability to inspire, mobilise and encourage people to achieve the goals of an organisation. A leader has to be organised, have the ability to delegate task and ensure that all the arms of the business is consistent with all the goals of the organisation. Beacon Edge Care Home lack leadership that is organised, coherent and the ability to inspire staff to meet the objectives of the home (Edwards, 2013). For instance, there was no registered manager on duty during the inspection and no senior management oversight to help ensure effective quality monitoring and improvements were carried out.   The management of Beacon Edge Care Home would need to employ a registered manager according to the Health and Social Care Act 2008. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulat ions about how the service is run. 1.2.2 Lack of management support Change is hard to implement without the support of the management. Shore (2012) suggested that management should be in the forefront of supporting desirable change because such change will increase the profitability of the company. It is obvious from the case study that the management of BECH is in shambles and the management do not have an idea of what is needed to improve the delivery of their services to their patients. This is one   of the main challenges facing the organisation. The managers must employ a democratic leadership that will enable all employees to cultivate a culture of quality assurance in order for BECH to meet the regulatory bodies requirement and to effectively meet the needs of their service user. 1.2.3 Financial Resources The process of implementing change in an organisation can be affected with lack of financial resources.   Financial resources maybe recruiting top notch manager, training employee to meet the expectation of customers or fund to acquire new equipment.   In the case of BECH, the business is faced with different problems and financial constraints maybe one of them. It could be the reason why the company did not employ competent and skilled workforce for effective management of their operations and services. 1.2.4 Lack of communication and coordination Communication at Beacon Edge Care Home was ineffective, wrong drugs are given to patients, staff are not clear on their roles and management Care plans were not focused on upon individual preferences, choices, needs and abilities, in addition, patients received inconsistent care because staff focused on tasks rather than supporting people with their individual needs and preferences. The roles of individual staff need to be defined and the quality of their work would need to be monitor by their supervisor. Supervisor should schedule meetings with staff on a regular basis to communicate what need to be achieved and the approaches staff need to deployed to achieve those goals. 2.1 In relation to the CQC report on Beacon Edge Care Home, the strategy and criteria for measuring recent changes in health and social care have to be effective and efficient.   Hence, it is essential to set up a system that will allow the organisation to know the changes made will work, how to know changes that resulted in improvement and which changes is most vital and have resulted in the most significant improvement. Thus, by collecting data before, during, and after the change have been implemented, Beacon Edge Care Home can measure, evaluate, and compare their home progress with respect to the goals set out. The process of measuring changes should be simple to implement and have immediate impact. Based on these facts, the researcher decided to deploy the use of questionnaires and surveys, interview with service users and employees and discussion with other stakeholders to measure improvement in the services provided by Beacon Edge Care Home. According to Davis (2010), criteria is a standard set by organisation as target that is decided upon.   Setting criteria will enable Beacon Edge Care Home to identify areas that needed improvement and base line for measurement. The Home will need to consider the new and previous recommendations made by CQC which that services provided by the Home have to be effective, responsive, safe, well-led and caring in order to meet the expectations of their service users. A strategy is the direction and scope of an organisation over the long-term: which achieves advantage for the organisation through its configuration of resources within a challenging environment, to meet the needs of markets and to fulfil stakeholder expectations. The plan for strategic and measurement will need to address the factors identified by the CQO in the report and to meet the criteria of the Health and Safety Act 2008. Questionnaire is a qualitative method that can be used to   measure gather information from service user about effectiveness of the service provided. According to Creswell (2014), questionnaire is a research instrument with a written set of questions given to people to collect facts or opinions about a study. It a relatively cheaper and efficient way of collecting large amounts of information a sample of people. In the case, the questionnaire will be design to rate the effectiveness of the service provided, if the staff are responsive and caring, also if the Home conduct risk assessment on their patients and their environment. This will provide a compressive idea of the changes that have been implemented is effective and improve the level of service to the stakeholders. Questionnaire is an effective instrument because it will provide management fast result and it can be easily quantified. It can be used to measure customer or staff satisfaction. Interview is a qualitative approach of gathering information from participants. Interviewing involves asking questions and getting answers from participants in a study.   Interviewing has a variety of forms including: individual, face-to-face interviews and face-to-face group interviewing.   The asking and answering of questions can be mediated by the telephone or other electronic devices (e.g. computer (Wiley, 2014). Interviews can be structured, semi-structure or unstructured. The use of interview techniques at Beacon Edge Care Home to collate data from patients and other stakeholders will provide an insight into the quality of service rendered by the organisation. This can be a semi structured interview by asking patients about specific question about the quality of service and the organisation is meeting their needs in terms of caring, responsive and effective. These approaches and strategies will enable the management of Beacon Edge Care Home to measure the effectiveness of the changes made to meet the criteria of the CQO. CQC drives improvement in the quality of health and social care services. It regulates against the registration requirements set out in regulations to the 2008 Act. These are the essential standards of quality and safety that providers are legally required to meet. These standards therefore represent the minimum quality bar which all providers of regulated activities must meet and should not dip below. 2.2 Measuring the impact of recent changes on health and social care services against set criteria Creswell (2014) defined data collection as the process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer stated research questions, test hypotheses, and evaluate outcomes. In the case of Beacon Edge Care Home, compliance and adherence report, employee engagement and participation, Issue, compliance and error logs, observation of behaviour change, employee feedbacks and employee readiness assessment results were used to measure the recent changes against the set criteria.   Observation of employee engagement with service users, issue, compliance and error logs as well as the employee feedbacks provided crucial information about the changes made at Beacon Edge Care Home against the recommendations made by the CQO. The changes ade by the manager of BECH has enhanced the communication between care workers and service user, improved the provision of person centred care, the management if medicine which was a major problem before and effective care home engagement to ensure that patients are not exposed to any hazard or risk that may cause them harm. 2.3 The overall impact of recent changes in health and social care The recent changes made by the manager and management has improved the quality of service provided by by Beacon Edge Care Home. The appointment of a registered person that understand the criterias and codes of conduct of health and social care, enabled the organisation to comply with various regulations and legislations. For instance, a competent and qualified person was assigned by the manager to monitor and measure health and safety procedures in the organisation. This include conducting risk assessment, reports of incident, communicating changes in operational model to management etc. The registered person on the other hand ensured that training and development are provided for employees, observation conducted to ensure staff are effective and responsive on delivering their duties and survey on patients to measure their level of satisfaction. In most organisation, changing the ways of doing things can either lead to positive or negative outcome. However, the most essential is to h ave management that is open to change and not afraid to implement new approaches. Hence, Beacon Edge Care Home need to continuously monitor and measure the changes that have just been implemented and also look for areas of improvement to in order to meet the ever-changing needs of their service users (Shore, 2012). 2.4 Propose appropriate service responses to recent changes in health and social care services There many approaches and techniques BECH can deployed to response to recent changes in health and social care services The Care Act 2014 underpin the way people receive care and provide a vehicle to communicate changes health and social care services. Regarding BECH, the management can response to recent changes in health and social care services through the following: Training: The case study highlighted BECH lack skilled employees that understand the regulatory requirement of working in health and social care organisation. This will need to be addressed either by employing skilled workers or providing training for old workforce to gain the competency of needed to be a care worker. Compliance with different regulatory bodies requirements: There were different breaches of regulations during the inspection by CQO. For instance, confidential data were not kept secured (Data Act violation), Health and Safety of service user and staff did not comply with the requirement of Mental Capacity Act 2005. The new registered person or manager has to ensure that the cultivate a culture of quality management and effective communication of different policies, procedure and regulations of health and social care to the workforce Continuous quality improvement of services rendered by the organisation: BECH should continue toi improve the level of their service delivery through the quality management tools like Kaizen quality control or quality cycle of Deming. According to Coy and Adams (2012) quality Management tools help organisation collect and analyse data for employees to easily understand and interpret information. Quality Management models require extensive planning and collecting relevant information about end-users. Customer feedbacks and expectations need to be carefully monitored and evaluated to deliver superior quality products. By embracing this approach, BECH, management will be able to meet and exceed the expectations of their service users. Embrace current best practice to treating people and supporting the specialist needs of people living with dementia:BECH provides care and home for people with dementia. It is essential the company lassie with other service providers, professional sand specialist in the field of providing care for people with dementia in order to provide appropriate and adequate service to their clients. Monitoring and managing medicines administered in the way that meet the requirement of the regulatory body: To meet the requirement of Mental Capacity Act 2005, the manager BECH have to monitor and manage the way drugs are administered to their patients. This was one of the findings in the inspection by CQO, patients were given the wrong drugs which can make their situation worse. 3.1 The key principles of change management In the todays business environment, change is inevitable and understanding the principles of change is equally vital. There different principles of change that Beacon Edge Care Home can deploy to meet the expectations of their service users and the objectives of the organisation. John M Fisher and John Kotter are change management theories that have made significant contribution to the subject. Others are Kurt Lewins change management model, Burke-Lewins causal change model; action research; gap analysis and Kà ¼bler Ross transition cycle. The researcher will focus on John Kotters Change Model that consist of eight stages. 3.1.1Establish a sense of urgency: Beacon Edge Care Home need to implement change immediately to meet the criteria and recommendations of the CQO 3.1.2 Form a powerful guiding coalition: The organisation need to employ a registered manager that will help coordinate the process to meet the recommendations set on the report about the Home. 3.1.3Create a clear vision; The manager and management have to set a clear vision on what they need to achieve and the changes that need to be made for the survival of the business. 3.1.4 Communicate the vision; The objectives will need to be communicated to the employees and other stakeholders. 3.1.5 Empower others to act on the vision: Training and development for employees, recruitment of skilled specialist is crucial to meet the vison set for change. 3.1.6 Plan and create short-term wins: The plan to me measurable in short term and long term to know if the changes implemented is working. 3.1.7 Consolidate improvements and produce still more change: Need to conduct survey, questionnaires and interview to measure improvement and benchmark the process in order to continuously improve the quality of the service delivery. 3.7.1 Institutionalise new approaches: After measurement of the impact of change and improvement, areas with positive outcomes and improve should be institutionalised. 3.2 How changes in health and social care are planned There are different approaches and techniques that can be deployed in health and social care setting to manage and plan change. However, it is essential to identify areas that needs change and improvement. Regarding Beacon Edge Care Home, the areas that need change and effective planning are the management style, Staff development needs, communication channel and reconditioning. In addition, changes in health and social care   have to consider the local authority, CCG, community needs, quality of care and finance available to BECH before planning can commerce. 3.2.1 Management style is the principles that underline the methods, abilities and techniques managers use in handling situations and expressing leadership within an organisation (Moss and Moss, 2012). The report on the services rendered by Beacon Edge Care Home by CQO was classified as been ineffective, unresponsive, unsafe and not well managed. The management style deploy by the organisation is not meet the needs of the service users and the goals of the Home.   The report indicated that employees do not have an understanding of their roles and duties, hence, the management are communicating with staff about what is expected of them. By embracing a paternalistic style of working the manager decide what is best for the employees as well as the organization. The policies are devised to benefit the employees and the organization. In addition, employee play a part in the decision making and roles and duties of individual staff are communicated to them. By deploying management style, employees would feel attached and loyal to the organisation. 3.2.2 Staff development needs is essential to meet the needs of the service users, in the report, CQO indicated that staff lack the essential training to be a mental nurse. And there were breaches of regulation in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. Lack of staff development through training has led to the health care provider providing inadequate care. There was also lack of effective communication channel between the management and employees which made it difficult for staff to understand their roles and duties in the establishment.   By investing in training and development, staff will be able to acquire the necessarily skills to conduct their duties appropriately and effectively. 3.2.3 Reconditioning refers to an organisation restructuring their goals and objectives to meet the criteria and regulations of sector they operate (Moosavi, 2009). Beacon Edge Care Home clearly deviated from the codes of conduct of health and social care and the criteria of the CQO. Reconditioning will enable the organisation to evaluate the regulations and legislation they have to adhere to meet the criteria of CQO in order to meet the expectations of their service users. 3.3 Monitoring recent changes in health and social care services Effective monitoring of change in the health and social care involves the systematic and analyse of information collected to measure change and meet objectives and help management to make informed decisions (Haluza and Jungwirth, 2016). The monitoring process comprises of internal and external analysis to measure changes. Internal analysis will usually involve supervisors, managers, clinical audit team, team leaders or a registered person. While, external monitoring comprises of CQC, CCGs, Monitor, Audit Commission and Health inspectors. Monitoring is essential in an organisation because it helps to track implementation and outputs systematically, and measure the effectiveness of programmes. It helps determine exactly when a programme is on track and when changes may be needed (Haluza and Jungwirth, 2016). There are various approaches Beacon Edge Care Home can embed to monitor the impact of change in the organisation, some of the techniques are reviewing the service delivery, supervi sion, shadowing, observation, audits, feedbacks, interviews and questionnaires. References Creswell, J. (2014). Research design. 1st ed. Los Angeles: SAGE Publications. Daft, R. (2011). Leadership. 1st ed. [S.l.]: South Western Cengage learning. Devorshak, C. (2012). Plant pest risk analysis. 1st ed. Cambridge, MA: Cabi. Edwards, N. (2013). Implementation of the Health and Social Care Act. BMJ, 346(apr03 1), pp.f2090-f2090. Green, G. (2002). Training and development. 1st ed. Oxford, U.K.: Capstone Pub. Haluza, D. and Jungwirth, D. (2016). ICT and the future of healthcare: Aspects of pervasive health monitoring. Informatics for Health and Social Care, pp.1-11. Kotter, J. (1999). John P. 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Carbohydrate and Peptide †Based Vaccines: The Way Forward

Abstract Existing treatments and therapies have supported a huge variety of diseases and infections, a significant example being antibiotics. However the increasing presence of multi-resistant bacteria, as well as increased changes observed in the mechanisms responsible for variation in viruses, involving accumulation of mutations within the genes that code for antibody-binding sites (known as antigenic drift), has resulted in these new strains not being inhibited as effectively by those treatments that originally targeted them (Reche, Fernandez-Caldas, Flower, Fridkis-Hareli and Hoshino, 2014). The knock-on effect has been that the bacteria or virus is able to spread more easily, and therapeutic treatments (used after a person contracts a disease), become less effective, unable to work by boosting the host’s own immune system. As a result, it has been recognised that the vaccine offers the advantage of preventing the anticipation of disease occurrence, using advance action to countera ct infection and chronic illness. Prophylactic, and to a lesser extent therapeutic, vaccines are the most cost-effective and efficient alternative to other treatments and prevention of infectious and chronic diseases. They work by causing changes to the T- and B-cells of the adaptive immune system to eliminate or prevent pathogen growth (Plotkin, Orenstein, and Offit, 2013). Going back to the introduction of vaccines more than 200 years ago, these were initially composed of killed pathogens, which although successful, also caused unacceptably high levels of adverse reactions. During the years of research that have since followed, as with the changes observed with antibiotics and other treatments becoming less effective, the need for safer and more effective vaccines has also been acknowledged. In addition, an improved understanding of antigen presentation and subsequent recognition has supported the development of newer vaccine types (Flower, 2013). Equally, whilst many diseases and infections are controlled by vaccines, for some, no vaccines have been developed, including Streptococcus pyogenes, human immunodeficiency virus (HIV) and hepatitis C virus (HCV) (Wang and Walfield, 2005; Barrett and Stanberry, 2009). Efforts to develop new vaccines are discussed in more details, with a focus on peptide-based and carbohydrate-based vaccines. Challenges are also discussed, leading to a summary of the potential direction of vaccination and research, which describes a promising future. Peptide-based vaccines An example of a newer category of vaccine is peptide-based vaccines. Peptides are short sequences of proteins, and diseases/infections use these proteins as part of their attack on the immune system. In many cases, the immune system has the ability to recognise the proteins associated with an attack by disease or infectious causing pathogens and can respond effectively. However as observed with many cancers, HIV, HCV and other conditions, an effective immune response is not triggered, hence the need for newer vaccine developments including those based on peptides, which encompass single proteins or synthetic peptides encompassing many antigenic determinants (B- and T-cell epitopes) (Flower, 2013). Peptide vaccines are a type of subunit vaccine, which presents an antigen to the immune system, using the peptide of the original pathogen, supporting immunity. Such peptide-based vaccines avoid the adverse effects described with traditional whole-organism vaccines (Moisa and Kolesanova, 20 12) with additional benefits also noted (Ben-Yedidia and Arnon, 1997), including: The absence of infectious material An immune response that is specific, focusing only on the targeted epitope, with the induction of site-specific antibodies No risk of an immune attack or cross-reactivity with the host tissues Flexibility, with an ability to modify products accordingly Improved effectiveness in relation to manufacturing on a large scale, and long-term storage where necessary e.g. a pandemic. However, a number of difficulties have been encountered during the development of such vaccines (Simerska, Moyle and Toth, 2011; Dudek, Perlmutter, Aguilar, Croft and Purcell, 2010) including: A short biological activity of peptides due to degradation by enzymes The trigger of a weak immune response when used alone i.e. single peptides Finding optimal delivery systems. As a result, and to overcome the difficulties mentioned above, synthetic peptide vaccines have been developed, on the basis that a greater more accurately targeted immune response will be achieved. Peptide antigens are not immunogenic by themselves, so this has led to investigations into co-administration of subunit peptide antigens with adjuvants (immunostimulants) to increase the peptide-induced responses to corresponding antigens. Appropriate delivery systems and often toxic adjuvants have demonstrated effective immunity, however, although many adjuvants are described in the literature, only a few have been approved for use with vaccines for delivery in humans due to their toxicity and include water/oil emulsions, liposomes, and bacterial lipophilic compounds to offer a few examples (Heegaard et. al., 2010). Incomplete Freund’s adjuvant (IFA) and Montanide ISA (both oil-based) have been used in clinical trials. Focusing on liposomes as another example, researchers have demo nstrated that use of lipid core peptide (LCP) technology (lipidation of peptides) improves the effectiveness of a self-adjuvanting vaccine delivery system, targeting a specific disease and triggering an effective immune response. This system provides a promising platform for human vaccine development (Zhong, Skwarczynski and Toth, 2009; Moyle and Toth, 2008). In animal models, peptide vaccines have been effective in generating the required immune response, and during recent years, peptide-based vaccines have advanced from animal models and pre-clinical studies, to human clinical trials (Yang et al., 2001). Although currently, all known peptide vaccines under development for humans remain at the stage of clinical trials, these trials should build on the promising evidence resulting from research to date of the potential application of vaccine candidates based on a LCP system, as well as other strategies. Prevention of not only many infectious diseases including hepatitis C virus, mal aria, human immunodeficiency virus and group A streptococci), but also for cancer immunotherapy and improved allergen specific tolerance, remains an exciting, and very real possibility. Carbohydrate-based vaccines The development of vaccines based on carbohydrates not only has quite a history, but is also an area that is fast moving in the current research world. The literature provides evidence as far back as the early 1900s where researchers discovered a connection between type-specific polysaccharides and the induction of antibodies being developed against certain types of pneumococci (Francis and Tillett, 1930). This was confirmed by evidence of pneumococcal capsular polysaccharides being used as vaccines, providing effective and long lasting immunity (Heidelberger, Dilapi, Siegel and Walter, 1950). However despite these early findings, the discovery and success of other treatments such as antibiotics and chemotherapeutics led to this area of research being put on hold. As mentioned earlier however, due to increased resistance to existing treatments such as antibiotics, coupled with the recognition for a need of newer treatments including improved vaccines, renewed interest into preventive vaccines has resulted in novel approaches, which include carbohydrate vaccines. Vaccines are commonly made from weakened pathogens, or, as we now know, other approaches also use immunogenic proteins or polysaccharides. Carbohydrates have been the centre of attention in the research field of vaccination because not only do they exhibit more stability than proteins, but they have roles in both physiology and pathophysiology, including cell interaction and signalling, inflammation, pathogen host adhesion/recognition, to name a few examples (Doshi, Shanbhag, Aggarwal, Shahare and Martis, 2011). During the last ten years or so, they have been used as adjuvants, as carriers for protein antigens to aid immunotherapy, and as targets for vaccines against bacteria. Additionally, as observed with DNA and proteins, carbohydrates are now recognised as biopolymers also, playing a role in many molecular and biological activities (Doshi et. al., 2011). These discoveries, partnered by an improved u nderstanding of the immune system and the identification of specific and relevant carbohydrate structures, led to the development of glycoconjugates, which in turn led to carbohydrate vaccine development (Holemann and Seeberger, 2004). Glycoconjugates are present in the surfaces of cells, as well as in the surrounding extracellular matrices and connective tissue. Therefore both the identified structure and presence of glyconjugates, plus the role they play, means they are a suitable basis for the development of new vaccines. Induction of protective antibodies is key to an effective immune response as a result of a vaccine, and as with peptide vaccines, challenges have been evident in the research to develop effective carbohydrate vaccines, including the following: Glycans struggle to effectively induce protective antibodies Carbohydrates have a low immunogenic impact by themselves (as observed with peptides). There are two main carbohydrate vaccine types: 1. Natural carbohydrate vac cines: these include small amounts of impurities 2. Synthetic carbohydrate vaccines: these are produced with no contaminants, and are cost-effective due large-scale production. Synthetic carbohydrate antigens used to develop vaccines have triggered immune responses in clinical studies and are favourable given the risk of adverse effects with natural vaccines. Four crucial aspects need to be considered for the design of carbohydrate-based vaccines (Astronomo and Burton, 2010): The antigen source: glycan antigens are diverse, ranging from large polysaccharide capsules, to small monosaccharides, to oligosaccharides, all of which have been shown to be adequate for preparation of vaccines. The carrier: this is most often proteins, although other materials have been investigated, with the aim of ensuring that the link between the antigen and the carrier is specific. The method of conjugation (or ligation): protein conjugates, lipid conjugates and polyvalent scaffold conjugates have been d eveloped. The success of a conjugate vaccine depends partly on the method of conjugation employed. This should be simple and efficient, as well as causing minimal distortion to the individual components involved, with many differing techniques used (Zou & Jennings, 2009; Ada and Isaacs, 2003). The choice of adjuvant: required to improve immunogenicity of the carbohydrate antigens being targeted, with a limited choice approved for use in humans. Examples of diseases targeted by carbohydrate-based vaccines The discussion will now move on to the use of carbohydrate-based vaccines in three disease areas: Group A Streptococcus (GAS), HIV/AIDS and Haemophilus influenza type b. GAS The need for a safe, effective, affordable and practical vaccine against GAS (also known as Streptococcus pyogenes), has been recognised for many years, as has the research into a vaccine against this disease, given the global burden on health that this disease causes in particular in less developed countries. More than 500,000 deaths result from the GAS each year, with the bacteria causing a range of both less complicated and life-threatening illnesses (Carapetis, Steer, Mulholland and Weber, 2005). The diversity of GAS strains is the major challenge for the development of an anti-GAS vaccine, with more than 100 different strains identified, of which the genetic sequence for several different strains have been determined (Johnson and Pinto, 2002). Rese arch has identified that GAS bacteria contain a surface polysaccharide made up of long, repetitive polysaccharide chains. The conserved and constant arrangement of these chains suggests conjugate vaccines to be an attractive and achievable option, with animal models supporting this theory (Cunningham, 2000). Synthetic carbohydrate vaccines, although only studied in a limited set of GAS infections, have demonstrated a protective immune response (Robbins et al., 2009). In addition, some areas of research have focused on the molecular analysis of a surface protein labelled the M protein, which is encoded by the emm gene. This particular gene has been found to be the major cause of GAS related clinical manifestations (Smeesters, McMillan and Sriprakash, 2010). These findings have allowed a greater understanding of the functioning of specific proteins responsible for the virulence of the disease, which in turn, supports the development of potential GAS vaccines. Vaccine prevention of GAS and the resulting symptoms and complications has been a goal of researchers for many years. A number of vaccines have been in research development to offer protection against GAS, with the research vaccine strategies focusing on either M protein, or non-M protein antigens (Smeesters, 2014). However only those vaccines that use the M protein as the antigen have progressed to clinical trials (McNeil et. al., 2005), and have included conserved antigens coverage across the many strains of GAS, a type-specific vaccine based on the N-terminal portion of the M protein, and a recombinant vaccine that reached phase II clinical trials (Pandey, Wykes, Hartas, Good and Batzloff, 2013; Bauer, 2012). However no vaccine has currently reached licensing and so the diseases caused remain uncontrolled in many areas, with reviews covering the research suggesting that even those vaccines developed with the aim of providing large coverage of GAS strains, these vaccine might achieve acceptable coverage i n developed countries, but in less developed countries where the disease burden is much greater, the positive impact of the vaccines would be much lower due to a greater strain diversity (Smeesters, McMillan, Sriprakash, and Georgousakis, 2009; Steer, Law, Matatolu, Beall and Carapetis, 2009; McMillan and Sanderson, 2013). Equally, antibiotic treatment is either impractical with regards to implementation (specifically in less developed countries) or ineffective. One research group targeted the bacteria by synthesising a new self-adjuvanting vaccine candidate, incorporating a carbohydrate carrier and an amino acid-based adjuvant, resulting in successful synthesis and characterisation of the vaccine candidate. This may contribute to the identification of a safe and effective vaccine against GAS in the future (Simerska et. al., 2008; Simerska, Lu and Toth, 2009). HIV/AIDS One of the main challenges researchers have faced within the field of vaccine development against HIV/AIDS, is that the virus surface is covered with layers of glycans, which conceal underlying viral antigens that are potential good targets in the production of vaccines (Scanlan, Offer, Zitzmann, and Dwek, 2007). They are produced by the host cell, which makes the virus appear as â€Å"self† resulting in no attack being triggered by the host immune system. The layers of carbohydrate also contain mannose residues, making these another potential target for a vaccine aimed at preventing HIV infection, whereby lectins preferentially bind to ? 1-2 linked mannose residues. Such lectins are being investigated as possible therapeutic tools (Tsai et al., 2004) although the fact that lectins are often toxic needs to be researched further to avoid the host immune system damaging host cells. Indeed, other drugs that are known to inhibit synthesis of carbohydrates only have this effect at often toxic concentrations to cause antiviral activity. Another strategy based on the same principle of developing a carbohydrate vaccine, is the identification of antibodies that again recognise and bind to glycans. (Scanlan et al., 2002, Scanlan et al., 2007). The antibody appears to recognize these glycans because although they belong to the host, they are arranged in a â€Å"non-self† manner (Scanlan et al., 2002; Scanlan et al., 2007), making the production of effective ant-HIV vaccines a real possibility, in addition to vaccines for other diseases such as cancer (Galonic and Gin, 2007). Studies have also been described using immune enhancing adjuvants, carrier peptides such as keyhole limpet hemocyanin and altered glycan structure constructs that support immune recognition in the development of vaccines against cancer (Galonic and Gin, 2007). These same strategies are being used in development of possible HIV vaccines, where antibodies target self-carbohydrates arranged slightly differently on cancer cells and HIV-infected cells, in comparison to healthy cells. (Galonic and Gin, 20 07). These approaches have not as yet led to clinically effective vaccines, but it is clear that antibodies that strongly bind to carbohydrate antigens on, for example, prostate cancer cells, have been generated (Slovin et al., 2003) and this appears to be a highly promising approach. Further exploration is required based on the carbohydrate coat of the virus, which may lead to improved prevention treatment of HIV. Haemophilus influenza type b The first synthetic vaccine for human application was developed in 2003 for protection against Haemophilus influenza type b vaccine, not only providing protection against this bacterium, but also against all the associated diseases it causes ranging from meningitis, septicaemia, pneumonia and arthritis (Doshi, Shanbhag, Aggarwal, Shahare and Martis, 2011). Indeed this bacterium is the leading cause of serious illnesses in children under 5 years worldwide. The majority of strains of Haemophilus influenza are non-encapsulated, and are lacking in any carbohydrate polysaccharide protective structure, as opposed to the GAS bacteria and HIV virus described earlier. This structural information armed researchers with the knowledge that carbohydrate polysaccharide conjugate vaccines would be required to ensure the development of an effective vaccine (Verez-Bencomo et. al., 2004). As a result, carbohydrate-based vaccines have been licensed for protection in humans against haemophilus influenza type b, using oligomerization and a carrier protein (Doshi et. al., 2011).Evidence of progressTo end this section of the discussion, several conjugate polysaccharide carbohydrate vaccines are now well into pre-clinical/clinical development, or have been licensed and are now commercially available. Examples of licensed vaccines include the following (Astronomo and Burton, 2010): Haemophilus influenza type b (Hib) – 4 carbohydrate-based vaccines are licensed via 3 different pharmaceutical companies: ActHIB and Hiberix; Pentacel; PedvaxHIB; and Comvax Neisseria meningitides A, C, Y and W-135 – 2 carbohydrate-based vaccines are licensed via the same pharmaceutical company: Menactra; and Menomune-A/C/Y/W-135 Salmonella typhi – 1 carbohydrate- based vaccine is licensed: TYPHIM Vi Streptococcus pneumonia variants – 2 carbohydrate-based vaccines are licensed via 2 different pharmaceutical companies: Prevnar; and Pneumovax 23. Examples of carbohydrate-based vaccines in development include the following, where the disease is described in addition to the phase of development (Astronomo and Burton, 2010): Breast cancer – with 1 vaccine at the preclinical phase and a second at phase I Prostate cancer – 4 vaccines are in development at the preclinical, phase I and phase II stages HIV-1 – 1 vaccine at the preclinical phase Group A streptococcus – 1 vaccine at the preclinical phase Group B streptococcus – 1 vaccine at phase II. Conclusion It is fact that vaccines have had a major role to play in the success of preventing and treating many diseases, however many challenges remain. Diseases exist for which no effective vaccines have yet been discovered, including HIV/AIDs. In addition, diseases that have been controlled by vaccines in some parts of the world continue to affect the lives of people adversely in other areas where infrastructures for vaccination are poor/non-existent. Continued research is necessary to develop vaccines not only for those diseases with no vaccine available, but also to improve the effectiveness of existing vaccines. In addition to research focusing on novel and promising approaches such as carbohydrate and peptide based vaccines, efforts also need to concentrate on areas such as lower cost, more convenient delivery of vaccines, and longer-term protection. The future direction of research in this field has become focused with the help of new evidence-based information and promising data. The advent of synthetic peptide-based and carbohydrate-based vaccines signified a new era for vaccines, over-taking traditional treatments and vaccines which have become either ineffective or only offer short term protection. As the discussion demonstrates, a number of vaccines are already successfully protecting humans against some pathogens and disease, with the potential for further vaccines to follow. Finally, and perhaps most importantly, it should be remembered that unlike drug-based medicines, vaccines primarily offer a cure, a goal all aim to achieve. Word count: 3130 (excluding references) References Ada, G. & Isaacs, D. (2003). Carbohydrate-protein conjugate vaccines. Clinical Microbiology and Infection. 9(2): p. 79-85. Astronomo, R.D. & Burton, D.R. (2010). Carbohydrate vaccines: developing sweet solutions to sticky situationsNature Reviews: Drug Discovery. 9: p. 30-324. Barrett, A.D.T. & Stanberry, L.R. (Eds.). (2009). Vaccines for Biodefense and Emerging and Neglected Diseases. Elsevier Inc., ISBN 978-0-3-69408-9. Bauer M.J., Georgousakis M.M., Vu T., Henningham A., Hofmann A., Rettel M., Hafner L.M., Sriprakash K.S. & McMillan D.J. (2012). Evaluation of novel streptococcus pyogenes vaccine candidates incorporating multiple conserved sequences from the C-repeat region of the M-protein. Vaccine. 30(12): p. 2197-2205. Ben-Yedidia, T. & Arnon, R. (1997). 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The Effects of Technology in Education - 3250 Words

Cheng Chang Burgess Olivia ENG 60 26 July 2012 The Effects of Technology in Education Modern technology has penetrated every aspect of our lives and made great impacts on our daily activities, especially in the area of education. The continuous infusion of technology in education has become an unchangeable tendency. Given the increased use of technology in education, much research has been done on the value of technology in education. However, none of the studies have answered all of the questions that are essential to determining whether continuous infusion of new technologies in education can improve the quality of education. Since a clear answer to this question is vital to help educational organizations to make decisions on how much†¦show more content†¦One of the drawbacks mentioned in the article â€Å"Technology: A Catalyst for Teaching and Learning in the Classroom,† is that technology is very expensive, requires ongoing support and constant upgrades, and is not as cost effective as other investments in education (Valdez 21). Some critics think technology is a waste of scarce resources in education (Valdez 22), because overspending in technology can leave inadequate funds for other pressing needs in education. The funds invested in new technologies can instead be invested in other ways such as arts, science laboratories and shops that allow for more hands-on learning (Valdez 21). Well balanced funding for all essential elements in education is an important strategy to follow in the reality of scarce resources in education. As stated by the author Sue Ferguson in the article â€Å"How Computers Make Our Kids Stupid,† computers and the internet distract students from real learning, which is evident by the poor academic achievement associated with excessive and improper use of computers and internet (Ferguson 2). This view is supported by a massive study conducted by University of Munich economists Thomas Fuchs and Ludger Woessmann in November, 2004, with a subject pool of 174,000 15 year-olds in reading, 97,000 each in math andShow MoreRelatedThe Effects Of Technology On Education1377 Words   |  6 Pages Amidst the past several decades technology has become a crucial organ, advancing our world to great discoveries and knowledge. It has opened doors to what some may have found impossible only one hundred years ago, but the progress of technology seems to have run into a road block. Inadequate education of high school graduates and suffocation of creativity has become a problem all over Ameri ca. 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