Critical Reflective Essay

Parent-children Relationships


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Different parents have their different ways of relating and dealing with their kids. You will find one parent who has more than one kid, and they treat all of them differently. In the world, disobedience from complicated to parents usually makes relationships harder. This essay will compare how the different parent-children relationships serve as lessons to today’s parents and children. In the Bible, there are various relationships from one family to the other. Some relationships between parents and their children are encouraging while others seem difficult. Either way, these relationships have an almost similar reflection to today’s parent-children relationships. In the Bible, some parents related well with their kids and both parents and children of the world today have an example to emulate or one they can identify with (Oakes, Lipton, Anderson, & Stillman, 2015). Besides, there are difficult relationships in the Bible which the parents and children of today have something to learn from. The story of Rebekah and her two sons, Esau and Jacob, will be used to portray both important and challenging relationships. Those who wish to train their children to obey have an example from the Prodigal son’s text. For parents who favor some children over their brothers and sisters can learn from Rebekah, the mother of Esau.

The customs – prodigal son’s story.

In the New Testament, Luke 15: 11-32, the story of the prodigal son is given in details concerning the younger son who went against not only the authority of the father but the community. There are two kinds of customs for the Jewish people of the first century which had a significant effect on the kind of relationship that the prodigal son had with his father. First of all, the son vacated from home after he asked for his inheritance at the wrong time only to misuse it all. It was not allowed for a father to share his belongings before his old age nearing death. (Hempenius, 2015). The younger son portrayed rebellion to the culture and also to his father by insisting that he wanted his share before the time was right. With this kind of disobedience to the Father and the customs, the younger son made the relationship between his father and self; difficult. It is not easy to deal with a child of yours that heeds no ear to the teachings of the community or yours as the parent. Thus with this kind of rebellion, it typically became a challenging parent-child relationship. When the father ran towards his lost son to welcome him back, he went against the custom of the then Jewish tradition. Any man was not supposed to show his barefoot and saw it would be shameful. The father bore the shame, by running (Luke 15:20), so as to save his son from being disowned by the community. His sacrifice displays another kind of parent-child relationship which can be termed as loving or read as helpful to many parents in the world today.

Prodigal son and the father.

When the prodigal son asked for his inheritance from his father it was wrong of him (Luke 15:12) He out rightly showed not only disobedience but also lack respect to his father and the community. His rebellion was an embarrassment to the father as he went to waste all the inheritance he asked for. He can be viewed as a rebellious and hard to deal with child by any parent. On the other hand, the Prodigal son also portrays respect and humility towards his father at the end of the text when he realized his mistakes and went to seek for forgiveness. His repentance shows humility and honor to a parent, and thus another kind of parent-child relationship is portrayed

When you consider the father, you may want to use his treatment of the son for another kind of parent-children relationship. For the father to agree to share his inheritance before his proper time, two kinds of virtues are portrayed for the existing parent-child relationship. The father could have chosen not to give out the inheritance to his younger son, but he decided otherwise. By so doing, he puts his son into the risk of wasting himself as he knew he was a spendthrift. If the father had no enough knowledge concerning his son’s reckless behavior of overspending, it could be read as his ignorance of his parental obligations. If he knew his son was a spendthrift and went ahead to give him all his inheritance, he then portrayed himself as a less caring parent who spoils their children way too much.

Comparison of the parent-child relationships based on the Prodigal son’s story and today’s and how it can be applied to both the parents and the children.

There are various helpful and stressful situations in the prodigal son’s story. In comparison to today’s relationships between parents and children; there is a lot to learn from (Oakes et al., 2015). First, there are very rebellious children in today’s generation. You will find a son wicked enough to plot his parents’ murder so as to get the inheritance. Others go haywire for the sole reason of disagreeing with the parents and end up on the streets after running away from home. Such rebellious children can be instructed or counseled using this story of the prodigal’s son. The prodigal son would not have eaten with the pigs if he only followed rules of the community and obeyed his father. Disobedient children of today can avoid future desperations and shame by following teachings of their parents and the community. Hence, from the Prodigal son’s disobedience, a challenging parent-child relationship can be dealt with using the story.

Again when considering how the father treated the lost son (Luke 15:20), parents have a lesson to learn on how to relate to a rebellious child. It is not easy for any parent to tell off their child because of a rebellious and humiliating thing they might have done. However, the pain sometimes becomes so much that a parent disowns the child to suffer out there. If there is a parent, who has difficulty in coming to terms with forgiving their children, the father from the prodigal son’s story can be a teaching for them.

The traditions – Isaac and Rebekah against Esau and Jacob

When considering an example of parents-children relationships, the story of Jacob and Esau suffices. When you go through the biblical accounts found in Genesis 25: 19 – 26, you will read about the family of Isaac and Rebekah and their twin. It was the custom of the Jews for the father’s blessings to go the son who had the birthright (Hempenius, 2015). Birthright naturally belonged to the firstborn son in a family. Following the line of the Jewish traditions, Esau who was the first child to Isaac and Rebekah automatically deserved the double portion from his father. However, through favoritism and deceit, Rebekah and Jacob managed to take away Esau’s blessing from the father. For Jacob to receive the father’s undeserved blessings, he had to play his brother. He ensured to impersonate his elder brother because he did not deserve the double portion as the younger son of Isaac. Rebekah as the parent, who favored Jacob more than her firstborn, helped him execute the plan so as to scoop Esau’s blessings. The whole incidence led to a long-term separation of the brothers to prevent Esau’s vengeance. (Genesis 27: 5-16), the kind of favoritism Rebekah portrayed indicates a type of parent-children relationship that you find in today’s families. Some parents who are materialistic love some of their children than others because they can help financially. Some of the other reasons you find favoritism in today’s relationships of parents and children include, but not limited to; education intelligence, familial backgrounds, and children’s personalities.

Rebekah and the two sons.

From the time Esau and Jacob were born and throughout their upbringing, Isaac loved Esau more while Rebekah loved Jacob (Genesis 25:27). This story is found in the Old Testament. The much love Rebekah had for Jacob led to her favoritism for Jacob and deceit of Esau which brought disputes between the two brothers. This kind of favoritism for one child than the other leads to indifferences and possible danger for the whole family. (Pillemer, Suitor, Riffin, & Gilligan, 2015). Favoritism of a parent to one child over the other quickly leads to family separations as we see in the case of Jacob and Esau when the former had to run to Haran to escape Esau’s wrath. Rebekah’s plan to deceive his son Esau shows an intricate relationship between her and the latter. When one fell hey are not preferred anywhere you feel out of place and unloved. Esau was inhumanly deceived which was made possible by Rebekah’s plotting. The deception (Genesis 27:35), of Esau did not end so well for either of the sons and thus the kind of relationship Rebekah had with her sons can be read as hard.

Another kind of relationship in this family can be adapted from Jacob’s obedience to his father and mother. Jacob did not deserve Isaac’s blessing for it was his brother who was older than him. However, Jacob stayed closed enough and followed his mother’s teachings, and that’s how he ended up getting the double portion. He escaped the wrath of his brother for he listened to his parents by running to hide at his mother’s brother, Laban, home (Genesis 27:44).He was also careful to marry from the desired tribe, and that’s why he saw to his family continuity.

Instructive accounts from the relationships between Isaac and Rebekah, and, Esau and Jacob.

In the story of Jacob and Esau, you find some of the parents- children relationships that exist today. When you consider Rebekah’s favoritism for Jacob over Esau, you can well relate to a story you heard from a neighbor or from a family you know about a favored child. As much as it is hard for a parent to hate on a child they have born, it gets different when it comes to the context of two or more sons of the same father. Most folks tend to lean on one child more than the other(s) for different reasons. You will find a parent who punishes one of their children often because they hate that they don’t perform in school when compared to other siblings. Another parent hates one child for the simple reason of naming from either of the grandparents’ sides. When you have such favoritism and hatred for own child you risk losing them and also causing fights in your family. When violent children like Esau are hated on, they can cause danger to the extent of killing their siblings. No one out there is born with the same personality with another (Mischel, 2013). It is not in anyone’s capacity to determine the kind of children they will bear. Parents are thus urged to learn to love each of their every child and treat them equally despite their differences (Psalm 127:3). The relationship between Rebekah and Esau can be used to counsel parents who favor one child over the other and help parents love their children the same way for otherwise; deeds can be dangerous to both the children. Favoritism as in the case of Rebekah will cause harm to the favored and the unfavored children. The separation of the brothers and Esau’s wrath shows the kind of harm a parent can cause their children out of favoritism.

When considering the beautiful relationship Jacob had with his parents, a sort of essential relationship between parents and children comes to mind. Jacob’s obedience for his father to marry a non-Canaanite saw to the family’s decent continuity. Children who are disobedient can be counseled using this account to motivate them to change for the better. In reading Jacob’s obedience to his mother (Genesis 29:1), two kinds of lessons can be given to children in relating to their parents. For one, Jacob managed to get the double portion thanks to his obedience for Rebekah his mother. For good things to happen, children can be taught to obey their parents as Jacob followed Rebekah’s teachings. On the other hand, this same obedience can be used to help children learn how to relate to their parents especially when they feel favored. Since Jacob knew it was not in his place, he was not the firstborn, to acquire the double portion he would have respectfully but firmly said no to his mother’s plot. It would have been possible to avoid the long separation between him and his brother Esau. Thus, children who have to favor parents can learn from Jacob to avoid following teachings of their favoring parents blindly to avoid harming their other siblings, themselves and the family at large.


From the two stories of the prodigal son together with Rebekah, Isaac, Esau and Jacob you get diverse kinds of parents-children relationships that are educative and helpful for the generation today. When you go throughout these stories, you very first and amazingly find today’s parents-children relationship that you can identify with (Oakes et al., 2015). You can almost find a neighbor or a family relative to relate with when it comes to the challenging and admirable relationships between parents and children in the biblical texts. When you use some of the stories given here to deal with the different relationships that exist today, change can erupt. The sacrificial, forgiving and real love for the prodigal son shown by his father is a text that can help counsel parents. A parent can be motivated to love, take in, and forgive their lost children who have brought them shame as it is in any parent’s place to love their children unconditionally. The story can also be used to counsel parents who love their children so much to the point of spoiling them. If the father denied the prodigal son the inheritance, which he was not supposed to share with him at that time, he would have saved his son the shame of desperation, eating with pigs. At the same time, children can be taught that sinning and separating from your parent does not mean the end of the relationship. A straightforward and humble sorry, repentance, can bring back the love between the parent and the child. When you put into consideration Rebekah’s favoritism for Jacob, you find two or more things that can help shape a parent-child relationship today. Rebekah caused the separation of his two sons due to her favoritism towards one of them. She could have avoided the wrath of Esau towards his brother and their eventual separation if she chose to love Esau as she did Jacob. Jacob did not have to run from Esau if Rebekah did not help Jacob deceive his brother. Some parents nowadays, favor or love one child more than the other which affects all the family members in the long run or even the community (Pillemer et al., 2015). The unfair dividing of inheritance has seen the death of some siblings, hatred between families and long-term separations. Besides, children who feel they have their parents favoring them more than their siblings can use the story of Jacob and Rebekah. Jacob could have avoided the sibling rivalry, between him and his brother, had he been careful and bold enough to say no to his mother’s plotting. Thus children can be counseled using Rebekah-Jacob’s relationship to avoid following teachings, from their favoring parents, against others as it could cause separation of families and related danger. From the prodigal son’s story, and, the family of Rebekah and her children, warning, motivation, and instruction to various kinds of parent-children relationships are portrayed.


The Bible: king James Version

Carlson, D. H. (2013). Jewish-Christian Interpretation of the Pentateuch in the Pseudo-

Clementine Homilies. Fortress Press.

Hempenius, E. J. (2015). Subsequent tale of the birth of eleven sons and one daughter is

Fundamental for the people of Israel, and also fundamental for the church of Christ. The sons of Jacob became the tribes of Israel and their names will be written on the gates of the New Jerusalem, coming down out of heaven (Rev. 21: 1-27, especially Rev. 21: 12). more important: Judah is born (Gen. 29: 35). He is mentioned in the lineage of Jesus Christ (Mt.

Mischel, W. (2013). Personality and assessment. Psychology Press.

Oakes, J., Lipton, M., Anderson, L., & Stillman, J. (2015). Teaching to change the world.


Pillemer, K., Suitor, J. J., Riffin, C., & Gilligan, M. (2015). Adult Children’s Problems

and Mothers’ Well-Being: Does Parental Favoritism Matter?.Research on aging, 0164027515611464.

Critical Reflective Essay

Parent-Child Relationships

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When growing up, I experienced both cordial and complicated relations with my parents. Parents relate to their children in unique ways which contribute to the development of different relationships. In the Bible, different parent-children relationships are portrayed, and some depict the dynamics of modern day relationships. In most cases when children are obedient and treated equally by their parents without any preferential treatment, their relations become easy to manage. Relationships between parents and their children are dynamic and challenging when either of the parties is difficult and antagonistic. Mostly, when kids reach adolescence, they become rebellious since this stage is characterized by confusion and desire to discover their self-identity. In the process, this affects their relationships not only with their parents but also with other adults. They find themselves constantly disagreeing with their parents, and they always demand the freedom to run their lives without external interference.

Parents also contribute significantly to deterioration of relations with their children. In particular, a family that has more than one child and parents decide to implement preferential treatment whereby they treat their kids differently causes jealousy and insecurity among the siblings. These relationships become complicated, and both the children and the parents suffer dire consequences. The effects associated with complicated child-parent relations in the modern world includes mental disorders such as depression and anxiety for both the parties. Hatred and resentment are prevalent among such parents which cause the children to develop low self-esteem since they are insecure about whether there are loved, they also experience suicidal thoughts which lower their performance in schools. However, not all relationships are broken and difficult, just like in the Bible, today some families enjoy cordial and warm relations between children and parents. This enables them to co-existence in happiness and attains growth in all aspects of their lives. Recent studies have proven that children who are raised in loving and caring are more self-confident and positive about life. Those who grow up in broken families are usually insecure and are negative towards life. The relations between parents and children both in the Bible and the contemporary world are dynamic and provide fundamental lessons to help mend the ever increasing number of broken families across the globe.

The Father and Prodigal Son’s Relations compared to Parent-child Relationships Today

In the modern times, many parents are facing hardships raising and dealing with their children. Children are commonly defiance and difficult to manage them; their environment has changed, and they are more susceptible to many dangers resulting from peer pressure. In the Bible, the prodigal son account is a good example of antagonistic children who end up moving out of their homes on their own. Teenagers and young adults tend to cause more problems in the relationships they have with their parents. Out of their strong desire for independence and freedom, these adolescents cause difficulties in their relations with parents and other family members. Most young people disagree with their parents and downplay their advice and therefore, fail to heed their warnings. The children do not want to be guided by their parents as they want to be up to date with what other peers are doing.

The modern world is complex and social media has been the most sort after platform for youngsters’ communication1. Children begin to behave like their favourite celebrities and desire to acquire their unorganized lifestyles. In order to live independently, an individual must be financially stable. Most young adults, however, lack the means to finance themselves since they have no jobs and lack income and hence, are highly dependent on their parents. These children decide to demand their share of the family inheritance at a young age. The parent can choose to yield to the child’s demand and give them the inheritance without considering the grave consequences attached. The majority of the young adults tend to be impulsive buyers and exaggerative in spending. Thus, parents withdraw their support towards such children since they are aware of the repercussions that result from spendthrift lifestyles of young adults. Therefore, the children become resentful which affects children-parent relationships negatively. In the extreme cases, children may plot murders against their parents as means to acquire the inheritance2. The story of the prodigal son, therefore, provides relevant lessons for this situation.

Young people go through emotional turmoil as they experience the subsequent development changes. This affects them, and they become easily irritated and inconsiderate when their demands are unmet. Children do not care if they offend their parents or not as long as they do what their peers are doing. Peer pressure is prominent at this stage and is associated with adverse consequences on teenagers and young adult; adolescents who prefer to follow the ways of their peers end up fighting their parents. The majority of college students waste their time and money in parties and clubs. Partying and clubbing have many serious consequences that make parents deny their children permission to attend to such events. Frequent partying takes up a lot of learners’ time which could be spent in personal development activities. For the college students, intoxication which is prevalent in parties has adverse effects on education and general life. The killing of innocent young people is rampant and mostly involves school students. I recall a young campus mate who was murdered in a nightclub fighting over a girl. The parent of the murdered student sobbed painfully seeing where her son’s disobedience had led to. The rebellious nature of the prodigal son resulted in his ruin while his father and brother continued to live in wealth. Today, the prodigal son analogy provides key lessons for both the parent and the children.

Children waste their parent’s resources in efforts to fit in certain groups of their peers who are living lavishly. Girls and boys in campuses are the most affected since they want to be at the top of the game. Boys are commonly driven by their need to lure girls into liking them. However, not all parents can afford to fund their children’s extravagant lifestyles. The financial constraints that affect families deteriorate the relations further3. The deviant children choose to engage in criminal activities to support their lavish lifestyles. Girls end up in prostitution to get enough money to buy fashionable clothes and also fund their expensive lifestyles. Brutal murders and kidnapping of such girls occur since the activities they engage in are dangerous. Most boys participate in drug trafficking which exposes them to external dangers and legal sanctions including serving jail terms. Such children end up losing their lives as they try to feed their greed for lavishness and upper social class. The prodigal son was motivated by his impulsive behavior, dissatisfaction of what his father offered, and disobedience. Such campus students who go to the extent of drug trafficking and prostitution are dissatisfied and face emotional upheaval. They are rebellious to the commands of their parents in which case just like the prodigal son they end up in misery.

Children are usually forced out of their homes due to their antagonistic nature. This creates distance between them and their family members causing too much suffering. Children are always in need of their parents’ guidance, and separation produces negative outcomes. Due to lack of guidance, children are left to handle life on their fails and experience many pitfalls. The prodigal son became hopeless and desperate after he left his father’s house in his will4. Parents suffer the loss when their children run away from home due to disobedience and non-compliance. The parents experience emotional pain which may cause them to experience disabling condition such as depression. In most cases, parents begin to doubt their parenting abilities and blame themselves for the children’s adverse outcomes. However, the parents should always be willing to take back their children after then learn their mistakes. The prodigal son’s father was forgiving and caring enough to allow his lost son back home. Today, parents might find it hard to forgive their children thereby create barriers in mending their already broken relationships. Parents should be willing to show unconditional love to their sinful children and help them recover from their downfall. The prodigal son’s father was able to restore his son’s mental, physical and even financial status. For relationships to work between parents and children, there must exist unconditional love. If the prodigal son’s father failed to give his son a second chance, their relationship would have remained broken. In order to have better parent-children relationships, the kind of forgiveness portrayed by the prodigal son’s father is necessary and should be emulated by all.

The primary factor that contributes to difficulties in today’s relationships between parents and children is pride. When one of the parties wrongs the other, they fail to apologize and ask for forgiveness. Lack of repentance and failure to grant forgiveness leads to more suffering for both sides. If the prodigal son did not swallow his pride and seek his father’s forgiveness, he would have never repaired the broken relationship. The impact of his repentance manifested through the establishment of new and better relationship between him and his father. This shows that parents need to allow their children to make mistakes and learn from them to heed their advice. Children should always ask for forgiveness just like the prodigal son and take part in their rescue after they have realized their mistakes. Parents should also apologize to their kids whenever they wrong them. This is key in establishing closer and more open relationship.

Fundamental Lessons in the parent-children relationships between Rebekah, Esau, and Jacob

Children’s defiance is one factor that makes relationships between them and parents difficult. However, children are not always the reason why relationships become hard; parents too can play a central role in making the relationship between them and their children difficult. Parents sometimes fail to balance the love among all their children and therefore fail to treat them equally. This disparity causes emotional pain to the kids as they feel rejected and unloved. Each and every child desire the unconditional love of the parents; however, situations may deprive children such tender and affection5. Whenever I feel afraid and insecure, I always run to my parents for reassurance. This helps me to face the challenges courageously. It is natural for people to be worn out along the way and we all need emotional support, particularly from our loved ones. Children are not treated equally by their parents tend to grow up resenting themselves as well as their family. This situation leads to complicated relations between the parents and the child. Preferential treatment should not be incorporated in our families. Jacob was separated from his brother due to their mother’s dislike and contributed to the deception of Esau which made him swear to kill Jacob. In today’s world, parents’ favouritism stems from a difficult parent-children relationship and contributes significantly to siblings’ rivalries and family break-ups. Many reasons make parents favour some children over the others; good academic performance, a personality that resonates with that of the parent, physical appearance including the complexion of the child. Parents should learn to deal with issues that cause disparities in the way they treat their children to save and enhance their relations with all of their children.

Some parents are driven by love for material things which makes them favour children who are financially stable over the others. This creates emotional torment among the children which breaks the family. Children are endowed differently concerning talents, career interests, and capacity; when the parent treats one child better than the others, children feel unloved and uncared for. The children who are unable to immerse great success in live find it hard to seek their parents’ support. The emotional disconnection between the disadvantaged children and the parent takes as a result and lead to more suffering for the children. The feelings of hatred towards the parent and envy for the esteemed sibling erupts and makes the child resentful. Feelings of vengeance like in the case of Esau may compel the child to hurt the family members to relieve the emotional pain6. It is thus important for parents to embrace equity when dealing with their children. Parents should disregard any differences that make them treat their children unequally since equality enhances parent-children relationships.

The case of Rebekah’s deceit and preferential treatment towards Jacob over Esau is not new in the contemporary world. Some parents today prefer to have some of their children get advancements in life than the other siblings. When a child performs well in various activities like school, the parent typically invests heavily on that single child while ignoring the rest. When the parents disregard the children who are not successful in life and focus on a single child is detrimental to their relations. Such children are filled with the emotions of hatred and anger towards their parents. Children who have parents with favouritism tendencies grow up hating one another as they perceived each other to be a threat to their success and progression. Like Jacob was separated from his brother due to their mother’s favouritism, children in the world today face the same consequences. Separation, hatred, and vengeance are some of the critical issues experienced in contemporary families7. Equal treatment of children is thus a necessity to enhance the parent-children relationships.


The parent-children relationships are threatened by diverse challenges in the contemporary families. Both the parent and the child need to learn from the kinds of relationships presented in the Bible. Issues like forgiveness and unconditional love should be adopted to repair the broken relationships. The unwillingness to accept one another makes the parent-children relationship complicated and hard to improve. Children’s defiance to the set values and norms is a significant threat to parent-children relationships; children, therefore, should participate in maintaining good parent-children relationships. There is a lot to learn from the Bible regarding the parent-children relationships and incorporate the lessons to eradicate the increasing number of broken families.


Carlson, D. Jewish-Christian Interpretation of the Pentateuch in the Pseudo-

Clementine Homilies. Fortress Press, 2013.

Mischel, W. Personality and assessment. Psychology Pres, 2013.

Oakes, J., Lipton, M., Anderson, L., & Stillman. Teaching to change the world.

Routledge, 2015.

Pillemer, K., Suitor, J. J., Riffin, C., & Gilligan, M. Adult Children’s Problems

and Mothers’ Well-Being: Does Parental Favoritism Matter?.Research on aging, 0164027515611464, 2015.

The Bible: king James Version

1 Oakes, J., Lipton, M., Anderson, L., & Stillman. Teaching to change the world. Routledge, 2015.

2 Mischel, W. Personality and assessment. Psychology Pres, 2013.

3 Carlson, D. Jewish-Christian Interpretation of the Pentateuch in the Pseudo-Clementine Homilies. Fortress Press, 2013.

4 The Bible: king James Version

5 Pillemer, K., Suitor, J. J., Riffin, C., & Gilligan, M. Adult Children’s Problems and Mothers’ Well-Being: Does Parental Favoritism Matter?.Research on aging, 0164027515611464, 2015.

6 The Bible: king James Version

7 Oakes, J., Lipton, M., Anderson, L., & Stillman. Teaching to change the world. Routledge, 2015.

The Relationship between HIV Infection and Cardiovascular Diseases

The Relationship between HIV Infection and Cardiovascular Diseases


There have been more than 30 million people across the world, that have been diagnosed as living with HIV today.  According to data from the NCBI, 2 million new infections are reported every year. Additionally, HIV infections have often been directly linked to numerous amounts of cardiovascular diseases when compared to infections found in uninfected people.  For this reason, cardiovascular diseases continue to be recognized as some of the major reasons for mortality among patients suffering from HIV.  Studies have found that patients that are treated under antiretroviral therapy have higher risks of suffering from cardiovascular diseases. Studies have yet to prove whether HIV itself may be associated with the increasing number of patients suffering from cardiovascular diseases.


The Human Immunodeficiency Virus is spread when the virus is directly inoculated into the blood or when there is direct contact with large amounts of mucosal fluids. Once the virus is introduced into the body, it attacks the CD4 cells and attaches itself onto these cells and other receptors such as the CCR5 and the CXR4 (UNAIDS). The virus then begins to infect the cells by transcribing the viral RNA onto the DNA. A series of activities then occur and eventually, the virus integrates into the host genome (Rivera, Grevious, Rodriguez et al., 2017). The virus may remain dormant or may begin to cause viral translation, which then leads to the various symptoms associated with the disease. When the virus begins to replicate, it leads to the destruction of the CD4 cells. This in turn affects the immune system of the infected patient and its dysfunction. When the CD4 cells decrease to a level less than 14%, the patient is said to be suffering from AIDS which is the acquired immunodeficiency syndrome. Once the patient is diagnosed as suffering from AIDS, it means that numerous amounts of opportunistic infections and malignances begin to develop on their body (MMWR, 1992).

Different patients experience different forms of infection depending on various underlying factors that can be allied with the different strains of HIV. For most people that suffer from the infection, they can continue to live with the disease for a long time, even as the virus continues to replicate and destroy the CD4 cells. The differences between this patients is whether they go through this time being clinically latent or suffering chronically (Hui, 2003). For some, theyare even able to control the levels of replication of the virus over time without the use of medication. However, without the necessary medication, most people develop HIV-related complications within 2 or 3 years after contact. It is estimated that the infections continue to increase through the years, and those living with the virus above the age of 50 years has also continued to rise (CDC, 2017).

Antiretroviral Therapy

The FDA in America has approved several Anteretroviral agents for use, amounting to sis in total. These are;

  1. Nucleoside reverse transcriptase inhibitors (NRTIs). These work by blocking the transcription process between the viral RNA and the host DNA.
  2. Non-nucleoside reverse transcriptase inhibitors (NNRTIs). These work by blocking the operation of the transcriptase enzyme.
  3. Fusion inhibitors. These work at the initial point of contact. they are aimed at inhibiting the infusion of the virus with the host
  4. Entry inhibitors. These work at the entry point and block the entrance of the virus into the body of the host. They do this by blocking the CCR5 which is the surface co-receptor.
  5. Integrase inhibitors. These are aimed at preventing the integration of the DNA of the virus into the genome of the host.

Sometimes, patients are required to have a combination of the various ARV agents. The aim of the treatments is to ensure that the patient reaches an undetectable HIV viral load.

Although majority of the patients have grown tolerant of the ARV drugs, they still continue to face several side effects. Most of the side effects are mild, including nausea, diarrhea and vomiting  (Paula, Falcão and Pacheco, 2013). However, some of the drugs such as the Efavirenz affect the central nervous system and can cause symptoms such as vivid hallucinations and other related symptoms. Some of these drugs, especially the PIs are responsible for several severe side effects such as Lipodystrophy syndrome, which is manifested in the form of fart wasting in the peripheral area of the human body as well as accumulation of visceral fat (Feingold, Krauss, Pang, Doerrler, Jensen and Grunfeld, 1993).

Clearly, from the various studies that have been conducted in the past, the most difficult side effects in terms of management have been those that deal with the metabolism of the patients. The different drugs offered for treatment and management of HIV lead to complications with the metabolism. For this reason, patients often suffer from abdominal obesity, hypertension, and other related illnesses associated with the ARV therapies, especially the PI therapy. According to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP), the metabolic syndromes exhibited by the patients can become risky to their health of they exhibit any of the following characteristics:

  1. If; for women, the waist circumference is greater than 88 cm and if it is greater than 102 cm for men
  2. If the blood pressure is higher than 130/85 mm Hg or if they are receiving drug treatment for hypertension.
  3. If the triglycerides levels are higher than 150 mg/ dL
  4. If the fasting glucose is higher than 100 mg/dL
  5. If; the  HDL cholesterol is less than 50 mg/dL in women or less than 40 mg/dL in men (Moyle, 2007).

Further studies indicated that a majority of the HIV patients started suffering from metabolism related complications after they started receiving their ARV treatments. After a study by INITIO, it was discovered that, patients that developed metabolism complications during therapy had a higher chance of developing cardiovascular complications that could eventually lead to their death during treatment. Other studies found that incidences of metabolic complications increased by 14% among adults suffering from HIV (Lifson,  et al, 2013). As discussed easier, many of these incidences are often more than likely to end in cardiovascular complications. These incidences in HIV infected adults have been linked to high levels of leptin and C-receptive proteins coupled with the decrease in the levels of adiponectin (Samaras, Wand, Law, Emery, Cooper and Carr, 2007). Additionally, according to various amounts of research, an increase in the levels of exposure to NRTIs and PIs among patients has been associated to an increase in insulin resistance. For this reason, patients taking PIs and NRTIs were seen to have higher levels of Insulin resistance as compared to patients that atazanavir. This is because these drugs contained stavudine that was seen to significantly reduce the levels of insulin resistance among patients (Fleischma, Johnsen, Systrom., et al,.. 2007).

Traditional Cardiovascular Risk Factors Are Increased In HIV Patients

Additionally, even without considering how the intake of the various ARV drugs affect the metabolism rates among HIV patients, various studies have found that the traditional  cardiovascular risk factors are increased among HIV patients (Bernal, Enrique et al., 2008). For instance, people without HIV are less likely to suffer from cardiovascular infections as a result of smoking when compared to HIV patients (Ingle, et al, 2014). Similarly, because of an increase in stress and other life altering factors, HIV patients are more likely to form the habit of smoking than the general population (Marks, Gardner, Craw and Crepaz, 2010). This, coupled with the fact that HIV infections lead to a change in lipid metabolism increases the chances of HIV patients from suffering from cardiovascular infections. Levels of cholestral begin to heighten even further among HIV patients once they are subjected to ARV treatment therapies. Studies have found that patients’ levels of cholesterol began to rise once they began to take their ARV drugs. These levels were significantly higher than when they did not take the drugs even if they had already been infected (Lo and Grinspoon, 2008). Data analyzed from various SMART projects has also led to the conclusion that HIV infection and its treatment with ARV drugs lads to an increase in the levels of D-dimer and cytokine II-6. These two factors are known to be very proinflamatory and are thus directly associated with an increase in cardiovascular infections among HIV patients (Dau and Holodniy, 2008).

Further studies have indicated that CVDs seem to develop earlier in life for people infected with HIV. Data from the Swiss cohort studies showed that after accounting for various risk factors in both HIV infected and HIV_uninfected persons, the persons with HIV showed a twofold increase in myocardial infarction. In even more recent studies, patients with HIV showed a higher risk of suffering from coronary related diseases when CD4 cell counts were less than 200 cells/µl.  Inflammation is one of the main contributors in the formation of artherosclerosis and other CDV related complications. HIV, being viral in nature, is known to increase inflammation within those that are infected. Elevetated levels of s-CRP and IL-6 as well as endothelial dysfunction are all HIV related issues that point at inflammation. HIV enbles inflammation through various methods including the direct work of the HIV RNA as well as tat and gp 120, both of which are proteins associated with HIV. Of course, these inflammation markers go hand in hand with the viral load and thus the CD4 count.

Sililarly, HIVs effect on blood lipids.  Data showing the occurrence of dyslipedemia on HIV patients before their cART treatments have been recorded and proven many times. The data has shown that within these patients, there is decreased low-density lipoprotein cholesterol, high density lipoprotein cholesterol and total cholesterol. These decreases go hand in hand with elevated levels of triglycerides. Whether this increases in the levels of triglycerides are the cause of an increase in the cases of CVD even in the uninfected population has been greatly disagreed upon, however, the elevation of these levels in HIV patients is indicative of this fact.

Regardless of the controversies on whether patients on stable cART are prone to CDV more than uninfected persons, studies have proven that these patients often show early signs of subclinical atherosclerosis. Although patients on cART have similar myocardial perfusion reserves to those in the normal population, a longitudinal study of patients that have not been treated has proven that their myocardial perfusion reserves decrease upon the initiation cART.  Myocardial perfusion levels have been linked with endothelial function or dysfunction. The fact that studies indicate that they are affected when cART is introduced proves that cART may be linked to CDV in HIV patients.

Pathophysiology of HIV-Associated Cardiovascular Disease

Through out this essay, drugs offered to HIV patients as ARV therapy have been linked to various issues regarding the metabolism such as; chronic inflammation and hypercoagulability (Wang, et al. 2007). Another issue that has been addressed is the fact that some of these drugs, especially the PIs affect insulin sensitivity among patients. It has also been mentioned that these issue are the most likely link between HIV infections and cardiovascular diseases (Boccara, Franck, Lang et al., 2013). HIV patients, even without the influence of ARV treatment therapies, have higher chances of getting cardiovascular related diseases  (Brooks, Kaplan, Holmes, Benson, Pau and Masur, 2009). This is because HIV influences endothelial functions through activated monocytes and cytokine secreted as a result of the activation. It is easy to calculate the differences between inflammation in healthy patients and those suffering from HIV. This can be done simply by studying the higher levels of more sensitive C-reactive proteins among HIV patients (Freiberg. et al., 2007). This is an indicator of the fact that HIV patients are more likely to suffer from Cardiovascular diseases (Hsue, Lo, Franklin, Bolger, et al., 2004). Additionally, other factors that affect inflammation may be considered to study patients suffering from HIV. These include interleukins whose levels increase among patients suffering from HIV. In addition to these, endothelial markers increase in their amounts as well. These are manifested in the form of soluble vascular cell adhesion among others (Wolf, Tsakiris, Weber, Erb and Battegay, 2004). These increases act as the best indicators of the likelihood of the occurrences of cardiovascular cases among HIV patients (Carrieri, Protopopescu, Roux et al., 2010).

Cardiovascular Diseases and  HIV Infection

Researchers have for a long time known the links between HIV infection and endothelial functions. One such example is the fact that nitric oxide acts as a mediator between endothelial dysfunction and the HIV infection (Marianna et al., 2006). When a patient is infected NO is produced excessively due to the reduction in the expression of endothelial NO synthase known as (eNOS) and, as a result, the increase in appearance of an incredible NO synthase (iNOS) (Leuven, Franssen, Kastelein, Levi, Stroes and Tak, 2008). When this occurs, the excess NO produced reacts with oxygen radicals leading to the production of peroxynitrate. Peroxynytrate is destructive to the vascular endothelium. The destruction of this endothelium then leads to the reduction in the flow of the mediated dilation (Torre, 2006).

In the beginning of the use of ART drugs, mortality was high especially for the first year. However, these mortality rates decreased thereafter. Afterwards, many of the mortality cases occurred for reasons that were not directly linked to HIV infections (Salyer, Jeanne, Debra, Settle et al., 2006). However, it has been found that some of these mortality cases may in fact be connected after all. for HIV patients, there have been numerous cases of premature coronary artery pathology. Studies conducted on those that have already passed on have shown that there is some connection between HIV and vascular endothelial pathology (Passalaris, Sepkowitz and Glesby, 2000).  Reports have indicated that since the introduction of PIs in the year 1996, there has been an increase in the number of clinically evident cardiovascular diseases among HIV infected persons (Zanni, Schouten, Grinspoon et al.,  2014). According to a recent study in the United States, HIV infected patients have higher risks of MI when compared to those that are not infected ( Triant, Lee, Hadigan and Grinspoon, 2007). Another Danish study also found that patients that underwent highly active antiretroviral therapy (HAART) were at a higher chance of being admitted into hospitals after suffering from ischemic heart diseases when they were compared to patients that were not undergoing the same kinds of treatments (Obel, Thomsen and Kronborg, et al., 2007). Similarly, studies by Kaiser Permanenete found that there were more cases of cardiovascular diseases in HIV patients that were not under any ARV treatment programs when they were compared to uninfected cases (Klein, Hurley, Quesenberry and Sidney, 2002). A combination of this studies leads to two conclusions

  1. The first is that HIV patients are more susceptible to being affected by cardiovascular diseases than those members of the society that are not infected
  2. The second is that HAART and ARV treatments increase the cases of cardiovascular diseases among HIV patients.


The studies regarding HIV patients undergoing HAART and ARV treatments indicated that it was important for these patients to have high CD4 counts if proper prognosis was to be made. Thus, for future references, patients must also be offered care for diseases that are not connected to their HIV infections. Additionally, due to the fact that the infected population, especially in more developed countries, continues to age, it is important that the relevant professionals are prepared to be able to deal with more cases of cardiovascular diseases. For this reasons, professionals will have to include HIV care with Cardiovascular care. Research must also be done to further ensure that ARV programs do not continue to endanger the lives of HIV patients by creating environments that encourage cardiovascular related complications. HIV studies must include the study of other diseases that appear to affect patients and that have been the leading causes of mortality among those who are infected.






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  8. Wolf K, Tsakiris DA, Weber R, Erb P, Battegay M. Antiretroviral therapy reduces markers of endothelial and coagulation activation in patients infected with human immunodeficiency virus type 1. J Infect Dis. 2002;185(4):456–62. [PubMed]
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  13. Obel N, Thomsen HF, Kronborg G, et al. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44(12):1625–31. [PubMed]
  14. Klein D, Hurley LB, Quesenberry CP Jr, Sidney S. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? J Acquir Immune Defic Syndr. 2002;30(5):471–7. [PubMed]
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  16. Hui DY. Effects of HIV protease inhibitor therapy on lipid metabolism. Prog Lipid Res. 2003;42(2):81–92. [PubMed]
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  18. Paula AA, Falcão MC, Pacheco AG. Metabolic syndrome in HIV-infected individuals: Underlying mechanisms and epidemiological aspects. AIDS Res Ther. 2013;10:32. [PMC free article] [PubMed]
  19. Brooks JT, Kaplan JE, Holmes KK, Benson C, Pau A, Masur H. HIV-associated opportunistic infections – Going, going, but not gone: The continued need for prevention and treatment         Clin Infect Dis. 2009;48:609–11. [PubMed]
  20. Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: A meta-analysis. AIDS. 2010;24:2665–78. [PubMed]
  21. Rivera M, Grevious S, Rodriguez A, et al. Update on Cardiovascular Disease and HIV. Heart Circ 2017; 1:006.
  22. Marianna K Baum, Carlin Rafie, Shenghan Lai, Lihua Xue, Sabrina Sales, J. B. Page, Ronald Berkman, Linden Karas, and Adriana Campa. 2006. “Coronary Heart Disease (CHD) Risk Factors and Metabolic Syndrome in HIV-Positive Drug Users in Miami”. American Journal of Infectious Diseases. 2 (3): 173-179.
  23. Bernal, Enrique, Mar Masiá, Sergio Padilla, Ildefonso Hernández, and Félix Gutiérrez. 2008. “Low Prevalence of Peripheral Arterial Disease in HIV-Infected Patients With Multiple Cardiovascular Risk Factors”. JAIDS Journal of Acquired Immune Deficiency Syndromes. 47 (1): 126-127.
  24. Boccara, Franck, Sylvie Lang, Catherine Meuleman, Stephane Ederhy, Murielle Mary-Krause, Dominique Costagliola, Jacqueline Capeau, and Ariel Cohen. 2013. “HIV and Coronary Heart Disease: Time for a Better Understanding”. Journal of the American College of Cardiology. 61 (5): 511-523.
  25. Carrieri M.P., Protopopescu C., Roux P., Spire B., et al. 2012. “Impact of immunodepression and moderate alcohol consumption on coronary and other arterial disease events in an 11-year cohort of HIV-infected patients on antiretroviral therapy”. BMJ Open. 2 (6).
  26. Ford, E.S., J.H. Greenwald, A.G. Richterman, A. Rupert, L. Dutcher, Y. Badralmaa, V. Natarajan, C. Rehm, C. Hadigan, and I. Sereti. 2010. “Traditional risk factors and D-dimer predict incident cardiovascular disease events in chronic HIV infection”. 24 (10): 1509-1518.
  27. Hsu, Denise C., and Irini Sereti. 2016. “Serious Non-AIDS Events: Therapeutic Targets of Immune Activation and Chronic Inflammation in HIV Infection”. 76 (5): 533-549.
  28. Hakeem A, S Bhatti, and M Cilingiroglu. 2010. “The spectrum of atherosclerotic coronary artery disease in HIV patients”. Current Atherosclerosis Reports. 12 (2): 119-24.
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  30. Lo J, and S Grinspoon. 2008. “Cardiovascular disease in HIV-infected patients: does HIV infection in and of itself increase cardiovascular risk?” Current Opinion in HIV and AIDS. 3 (3): 207-13.
  31. Lytwyn, Matthew, Nazanin Fallah-Rad, Jonathan Walker, Sheena Bohonis, Farrukh Hussain, Ivan Barac, and Davinder S. Jassal. 2010. “The Utility of Dobutamine Stress Echocardiography for the Diagnosis of Coronary Artery Disease in the HIV Population”. 27 (10): 1228-1232.
  32. Miller, Louis H., and John T. Coppola. 2011. “Noninvasive Assessment of HIV-related Coronary Artery Disease”. Current HIV/AIDS Reports. 8 (2): 114-121.
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Land laws: Mortgages



















Land laws: Mortgages

A mortgage is a loan given by a creditor to a debtor with a consideration of a property that belongs to the debtor. Once the debt has been cleared, the title in the property will revert back to the debtor. The property in this case (land) is transferred to the lender, but is subject to redemption. According to Lord Lindsey, a mortgage is “a transaction under which land or chattels are given as security for the payment of a debt or discharge of some obligation.”[1]The mortgagor (giver of the loan) enjoys ownership, even if is joint ownership of the asset in question until the mortgagee can fully pay back the loan.

The major laws that govern mortgage transactions are found in the Law of property Act 1925 and the Law of registration of Land 2002. Mortgages can either be legal mortgages or equitable mortgages. The difference being that; in a legal mortgage,the debtor has a legal interest in the property and most jurisdictions have a legislation to regulate them. An equitable mortgage on the other hand is one that is majorly implied, the court will therefore be left with the task of deciding if it meets the elements of a valid legal mortgage. The courts will give priority to the legal mortgage over the equitable mortgage in enforcement when both appear on the same property[2].

Looking at the history of mortgages during the common law, one will notice that there has been a significant change. Before 1926, once a party had committed to payment of a loan by a certain date the property would pass to the debtor automatically in case of default. Equity came in to try and remedy this defect and allowed for the equitable right of redemption. This principle allowed for the repayment of a mortgage loan even after the expiry of the contract duration. [3]

In a mortgage contract, both the mortgagor and the mortgagee reserve certain rights. The rights that protect the mortgagor are majorly based on the equity of redemption. The equity of redemption was developed by the courts of Equity to remedy a defect in the common law. This equity principle came to allow a debtor to still be able to redeem their property in case of lapse of payment duration.

The other aspect of this principle is that a mortgagor has a right to early redemption. This was shown in the case of Fairclough v Swan Brewery Co. Ltd[4], which involved a mortgage contract that was expected to last for twenty years with monthly installment payments.  The contract also contained a provision that the last installment was payable about six weeks before the lease ended. The mortgagor purposed to redeem the mortgage earlier and therefore went to court. The court held that the particular clause made the mortgage irredeemable and that the mortgagor was entitled to redemption of the mortgage.

Case law shows that any fetter or clog that may seek to prevent the equity of redemption is majorly considered to be void. A mortgagor is by law protected from any oppressive contractual terms, any collateral terms that may favor the mortgagee and undue influence. In case involving Cityland and Proprety Holdings v Dabrah, a tenant borrowed a loan from the landlord to buy the freehold of his house. The landlord imposed a premium on the interest and Dabrah was to pay back the loan at an interest rate of twelve percent. The court held that the interest rate of twelve percent was unfair since the parties had unequal bargain power and that the most appropriate interest rate was seven percent.[5]

According to the Land Property Act, a mortgagor reserves the right to sell the property and also the right to lease the property.  The borrower will have to inform and get approval of the mortgagee before they perform such an action. This right is also possessed by the mortgagee when they have possession of the property or if the foreclosure allows it to happen. This was seen in the famous Horsham case that involved the debate on two issues that the mortgagor’s rights provided by the European Convention on Human Rights had been violated when the mortgagee’s right to sell the property was enforced.

The mortgagee also enjoys certain legal rights. They have a right to sue for breach of a contract and that will be limited to a twelve year duration after which they lose the right.[6] The mortgagee will have a right to possession of the property that has been mortgaged. In the case of Four-maids Ltd v Dudley- Marshall[7] that involved a defendant who charged his property worth six thousand pounds; the contract terms provided that the principal sum would not be recalled earlier than December 17, 1958 if the defendant paid the interest within seven days when it was due. On failure to comply with the terms the plaintiff served, the defendant with a written notice for payment of both the interest and the principal sum and later applied for an order for possession of the property. The court held that the mortgagee’s right to possession of property was valid in the absence of implied or expressed terms that contract the right.

The court in the case of HorshamProperties Group Ltd v P Clark & C Beech[8] was of the opinion that the lender reserved the right to sell the property. In the case, the plaintiff was seeking the declaration by the court that the lender’s action of appointing a receiver to sell the house pursuant to section 100(1) of the Law of property Act was contrary to article 1 of Protocol 1 that provided the right to peaceful enjoyment of property. This case enforced the mortgagee’s right to possession of property as provided for in the Law of property Act. In the case of White v City of London Brewery Co[9], the court of appeal held that a mortgagee in possession of the property had to account for any profit or rent received. In the case of Silven Properties Ltd v Royal Bank of Scotland[10], where the plaintiff went to court to have the defendant make the property valuable when selling it, the court held that the mortgagee had no such duty.

The courts have however been empowered by the Administration of Justice Act[11] which allows the courts to suspend, postpone or adjourn proceedings foran order of possession provided that the mortgagor appears to have the potential to pay or ability to amount due in reasonable time. In the case of Cheltenham& Gloucester Building Society v Norgan, the presiding judge LJ Waite expounded on the AJA stating thata judge should give the mortgagor a period that is favorable so as to avoid repeated applications by the mortgagors on the same issue and a just hearing for the mortgagee at the lapse of the extended time.[12]

In the question involving Rees, who took a mortgage from Grantwill bank to complete payment on a house he purchased at Lovenest in Watfield and has now defaulted in payment for six months the advice given to him by the bank is unreliable. Mr. Rees got advice from the back that in the case of early redemption he needed to pay a penalty. He can take Grantwill bank to court seeking that the bank upholds his equitable right of redemption and relaying on the section 36 of the AJA seek a time extension on payment.

Mr. Rees using the case of Cityland and Proprety Holdings v Dabrah can claim that the Grantwill in imposing such a term in the redemption clause that would make him pay a penalty was an infringement of his right to redemption.  In the case, the court held that the mortgagee had a greater bargaining power which was detrimental to the plaintiff. Grantwill being the lenders are at an advantaged position since they can set the terms of the contract that may disadvantage the borrowers.Mr. Rees can also show undue influence by the bank since the advice given was not recommendable to the client.

Using the Administration of Justice Act[13] Mr. Rees can seek the extension of time for his payment of the debt. He can show the court that the two options of selling his business or pursuing the trust fund are enough for probability of payment of the mortgage with time extension. The trust that Mr. Rees relies upon may be challenged by Grantwill claiming it to be mere speculation. In Hastings and Fanning v Goddard the court decided that mere speculation of a trust will not be considered a valid trust.The court in considering the time extension will have an obligation to extend by a period that is favorable to Mr. Rees. Mrs. Rees being pregnant can hinder the bank from possession of the house to violate her right to special case and protection. Being that Mr. Rees is a beneficiary under a trust from the will of his late aunt, he can use this to prove to the court that she has the capability of making the required payments if he is granted an extension.

Evidently, there are very many laws that are governing the mortgages and the way they should be carried out. This is not in a bid to discourage its taking up. On the contrary it is so as to protect the interests of both parties and make the transactions involved as fair as possible. It is a very controversial field but as time goes by, there are different laws and amendments being made in a bid to make it more accessible, affordable and reliable.

The mortgage contract between the Mr.Rees and Grantwill bank needs to have fair and equitable terms to allow both parties to comply with the contract. The law protects both the mortgagor and the mortgagee giving the court the task in making sure that no one who comes to court will feel that justice has been served to them[14].













  1. Santley v Wilde1899 A 2 Ch 474
  2. Fairclough v Swan Brewery Co. Ltd(1912)A.C. 565
  3. Limitations Act 1980 section 20
  4. Four-maids Ltd v Dudley-Marshall 1957 1 Ch 317
  5. Horsham Properties Group Ltd v P Clark & C Beech 2008 H.C
  6. White v City of London Breweries Co 1889 42 Ch D 237
  7. Administration of Justice Act 1970 Section 36
  8. WOOD, P., & WOOD, P. (2007) Comparative law of security interests and title finance. London, Sweet&Maxwell. SINGER, J. W., BERGER, B. R., DAVIDSON, N. M., & PEÑALVER, E. M. (2014). Property law: rules, policies, and practices.
  9. TYLER, E. L. G., YOUNG, P. W., CROFT, C. E., & FISHER, W. R. (2005). Fisher & Lightwood’s law of mortgage. [Sydney], LexisNexis Butterworths.
  10. SINGER, J. W., BERGER, B. R., DAVIDSON, N. M., & PEÑALVER, E. M.(2014). Property law: rules, policies, and practices
  11. AMERICAN BANKRUPTCY REVIEW, INC. (1932). Conduct of mortgage foreclosures during bankruptcy. New York, N.Y, American Bankruptcy Review




[1]Santley v Wilde1899 C.A 2 Ch 474

[2] TYLER, E. L. G., YOUNG, P. W., CROFT, C. E., & FISHER, W. R. (2005). Fisher & Lightwood’s law of mortgage . [Sydney], LexisNexis Butterworths.

[3] SINGER, J. W., BERGER, B. R., DAVIDSON, N. M., & PEÑALVER, E. M.(2014). Property law: rules, policies, and practices.

[4]Fairclough v Swan Brewery Co. Ltd(1912)A.C. 565

[5] AMERICAN BANKRUPTCY REVIEW, INC. (1932). Conduct of mortgage foreclosures during bankruptcy. New York, N.Y, American Bankruptcy Review.

[6]Limitations Act 1980 section 20

[7]Four-maids Ltd v Dudley-Marshall 1957 1 Ch 317

[8]Horsham Properties Group Ltd v P Clark & C Beech 2008 H.C

[9]White v City of London Breweries Co 1889 42 Ch D 237

[10]Silven Properties Ltd v Royal Bank of Scotland[10][2003] EWCA Civ 1409,4 All ER 484

[11]Admininstration of Justice Act 1970 Section 36

[12] WOOD, P., & WOOD, P. (2007) Comparative law of security interests and title finance. London,  Sweet& Maxwell.

[13]Administration of Justice Act 1970 section 36

[14] SINGER, J. W., BERGER, B. R., DAVIDSON, N. M., & PEÑALVER, E. M.(2014). Property law: rules, policies, and practices.

Understanding assessment of children’s learning

Understanding assessment of children’s learning










To be retained by parents/guardian only

Understanding assessment of children’s learning

Assessment-Year 3

We would like to inform you that the school is planning to start an assessment for the learning of year 3 pupils. The learning assessment will be conducted by the class teacher with the help of the school administration and you as a parent.

Assessment of the children’s learning is voluntary. Deciding that your child should not be assessed will not affect his or her current class performance. Before you make a decision on whether your child will be assessed, it is good for you to have an understanding of the importance of assessing children’s learning and what will be your role in the assessment. Please take sufficient time to go through this information and if you wish you discuss it with other people. Ask the school assistant principal using the contacts below if you want more information or there is something you clarity.

What is the purpose of the learning assessment?

Assessment is one of the integral parts of teaching and child’s learning. It is a tool that will be used to collect evidence about the achievements of the children. Being aware of what is assessed and how learning will be assessed will help the teacher, students, and parents/guardians to gain a deeper understanding of what should be valued and where to focus the attention.

Assessment will be used for several purposes, but the main purpose will be to support the learning of the students ((Gardner, 2012).

Currently, there are 30 students in the class (18 boys and 12 girls) with a different range of abilities and in order to ensure that they all obtain excellent performance, the school has decided to implement an assessment program. Assessment will enable the class teacher to find out what each child understands, how each child thinks, what each child is able to do, and what is their interests and dispositions. This information will help you and the class teacher builds understanding of your child as competent and capable learner in order to support his or her further development and learning (Stiggins, Arter, Chappuis, Chappuis & Educational Testing Service, 2006. The teacher will use information collected from the assessment to give feedbacks to students and their parents about their improvements. Assessment feedbacks will also provide enjoyable and challenging learning environment and experiences to the students, choose the most appropriate support for each child, and make sound plans for the next steps (Gardner, 2012).

How will assessment information collected

The class teacher will use different methods of collecting information about each child’s progress in their development and learning. The class teacher will decide which method is best depending on the student being assessed, and the aspects of development and learning being focused on. In choosing the assessment method, the class teacher will be mindful in the background, culture, language, interests, abilities, and areas that need extra support. For instance, the class linguistically and culturally diverse with over 15 different languages. The school will ensure that the chosen assessment method is compatible with each child’s language and culture. There are also 2 girls and 1 boy in the class from an indigenous background. The method chosen for these three students will be mindful in their background. There is also a child in the class with moderate hearing loss and the school will ensure that he is assessed using a method that cares for this disability. There are also two children in the class that need learning support and the teacher only receives four SLSO hours each day. The assessment methods used will also help the children improve their technology usage in the classroom since the school has an interactive smart board. The Internet will be used sometimes to help children develop their learning.

Methods of assessment

Assessment will be done formally and informally. There are five methods of assessment that will be used:

1. Diagnostic- This type of assessment used to provide intervention opportunity and feedback. It helps a teacher determine the strengths, skills, weaknesses, and knowledge before issuing instructions (Killen, 2005). An example of this method is “The Unit Pretest” whereby prior to starting to teach a particular unit, a teacher creates an assessment to find out what children understand about the topic.

2. Formative- Teachers use this method to improve the learning of the students. It is a collection of methods used by teachers to carry out an in-process assessment of the learning needs and the progress of a child during a unit or a example of formative assessment is the observation that helps a teacher know what each student does and what they do not understand.

3. Summative- This method is used to assess the learning of the students after completion of each unit or lesson by comparing their performance with some standards (Killen, 2005). An example of a summative assessment is standardized exams such as SATs.

4. Formal- This is an assessment method that has some information that supports the conclusions that teachers make from test results (Killen, 2005). A good example of this type of assessment is standardized tests.

5. Informal- Unlike formal, informal assessments do not have supporting data but they are performance and content driven. An example of the informal assessment is grading, a method used by teachers to assign a value to the work of a student (Marzano & Association for Supervision and Curriculum Development, 2006).

Possible benefits

The assessment is intended to improve the performance of all students in the class.

How to get further information

If there is something to need clarification, contact the assistant principal via the school telephone number on 020 766 388.

Thank for spending your time to read this information sheet.


As far as education or learning is concerned, assessment or evaluation of students on what they have been learning is a central factor. According to my point of view it makes no sense for students to go through a course and finally fail to be evaluated. Assessment is the only way used by educators to know whether they have been teaching the right content or not. However, bearing in mind that the ability of students vary the educators came up with the above methods of assessment covering all types of students. This is to show that every child is able to access education no matter their mental ability and their physical composition. This was aimed to bring equality to all children and to wipe out discrimination. This great job by educators is worth appreciation because all students can go through learning and assessment.



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Gardner, J. (2012). Assessment and learning. Los Angeles [i.e. Thousand Oaks, Calif.: SAGE Publications.

Killen, R. (2005). Programming and assessment for quality teaching and learning. Southbank, Vic: Thomson Learning.

Marzano, R. J., & Association for Supervision and Curriculum Development. (2006). Classroom assessment & grading that work. Alexandria, VA: Association for Supervision and Curriculum Development.

Stiggins, R. J., Arter, J. A., Chappuis, J., Chappuis, S., & Educational Testing Service. (2006). Classroom assessment for student learning: Doing it right — using it well. Princeton, NJ: Educational Testing Service.

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Understanding assessment of children’s learning.

Understanding assessment of children’s learning










To be retained by parents/guardian only

Understanding assessment of children’s learning

Assessment-Year 3

We would like to inform you that the school is planning to start an assessment for the learning of year 3 pupils. The learning assessment will be conducted by the class teacher with the help of the school administration and you as a parent.

Assessment of the children’s learning is a very vital tool that helps teachers and parents monitor the progress of children in school. Deciding that your child should not be assessed will not affect his or her current class performance. Before you make a decision on whether your child will be assessed, it is good for you to have an understanding of the importance of assessing children’s learning and what will be your role in the assessment. Please take sufficient time to go through this information and if you wish you discuss it with other people. Ask the school assistant principal using the contacts below if you want more information or there is something you clarity.

What is the purpose of the learning assessment?

Assessment is one of the integral parts of teaching and child’s learning. It is a tool that will be used to collect evidence about the achievements of the children. Being aware of what is assessed and how learning will be assessed will help the teacher, students, and parents/guardians to gain a deeper understanding of what should be valued and where to focus the attention.

Assessment will be used for several purposes, but the main purpose will be to support the learning of the students (NSW Education Standards Authority, 2012).

Currently, there are 30 students in the class (18 boys and 12 girls) with a different range of abilities and in order to ensure that they all obtain excellent performance, the school has decided to implement an assessment program. Assessment will enable the class teacher to find out what each child understands, how each child thinks, what each child is able to do, and what is their interests and dispositions. This information will help you and the class teacher builds understanding of your child as competent and capable learner in order to support his or her further development and learning (NSW Education Standards Authority, 2012). The teacher will use information collected from the assessment to give feedbacks to students and their parents about their improvements. Assessment feedbacks will also provide enjoyable and challenging learning environment and experiences to the students, choose the most appropriate support for each child, and make sound plans for the next steps (Australian Federation, 2017).

How will assessment information collected

The class teacher will use different methods of collecting information about each child’s progress in their development and learning. The class teacher will decide which method is best depending on the student being assessed, and the aspects of development and learning being focused on. In choosing the assessment method, the class teacher will be mindful in the background, culture, language, interests, abilities, and areas that need extra support (UNSW Australia, 2015). For instance, the class linguistically and culturally diverse with over 15 different languages. The school will ensure that the chosen assessment method is compatible with each child’s language and culture. There are also 2 girls and 1 boy in the class from an indigenous background. The method chosen for these three students will be mindful in their background. There is also a child in the class with moderate hearing loss and the school will ensure that he is assessed using a method that cares for this disability. There are also two children in the class that need learning support and the teacher only receives four SLSO hours each day. The assessment methods used will also help the children improve their technology usage in the classroom since the school has an interactive smart board. The Internet will be used sometimes to help children develop their learning.

Methods of assessment

Assessment will be done formally and informally. There are five methods of assessment that will be used:

1. Diagnostic- This type of assessment used to provide intervention opportunity and feedback. It helps a teacher determine the strengths, skills, weaknesses, and knowledge before issuing instructions (Australian Federation, 2017). An example of this method is “The Unit Pretest” whereby prior to starting to teach a particular unit, a teacher creates an assessment to find out what children understand about the topic.

2. Formative- Teachers use this method to improve the learning of the students. It is a collection of methods used by teachers to carry out an in-process assessment of the learning needs and the progress of a child during a unit or a example of formative assessment is the observation that helps a teacher know what each student does and what they do not understand (Australian Federation, 2017).

3. Summative- This method is used to assess the learning of the students after completion of each unit or lesson by comparing their performance with some standards (Australian Federation, 2017). An example of a summative assessment is standardized exams such as SATs.

4. Formal- This is an assessment method that has some information that supports the conclusions that teachers make from test results (Australian Federation, 2017). A good example of this type of assessment is standardized tests.

5. Informal- Unlike formal, informal assessments do not have supporting data but they are performance and content driven. An example of the informal assessment is grading, a method used by teachers to assign a value to the work of a student (Australian Federation, 2017).

When and how feedback is provided to children and parent/care givers

Written assessment feedback reports will be sent home at the end of each term. Parents/caregivers will be sent a summative report of each term’s/year’s results based on your child’s understanding, skills, and knowledge that will be measured against the country’s education performance standards, social and personal development. Additionally, class newsletters, displays and learning presentations, and meetings with parents and students need arise, and display of class programs and achievements of students are ways that will be used provide feedback to parents/cares about the student’s learning progress. Teacher-parent discussions will be conducted after each end term exam. At this time parents will be invited to meet the class teacher to discuss about their children’s developments in order to identify the child’s strengths and the areas that need reinforcement and make plans for his or her progress.

How to get further information

If there is something to need clarification, contact the assistant principal via the school telephone number on 020 766 388.

Thank for spending your time to read this information sheet.


As far as education or learning is concerned, assessment or evaluation of students on what they have been learning is a central factor. According to my point of view it makes no sense for students to go through a course and finally fail to be evaluated. Assessment is the only way used by educators to monitor the progress of all students in class. According to NSW Education Standards Authority (2012), assessment helps teachers, students, and parents/guardians to gain a deeper understanding of what should be valued and where to focus the attention. This is because it helps teachers to learn more about each student’s thinking, understand, and abilities in class (NSW Education Standards Authority, 2012).

The mode in which assessment information is collected is a very determining factor. According to NSW Education Standards Authority (2012), the method used to collect assessment information should be focused on evaluating the depth and breadth of learning based on the interests, cultural backgrounds, linguistics, abilities, and needs of the students. The method that will used in the classroom assessment will care for all these considerations. Providing assessment feedbacks to the students and parents/caregivers is an integral part of learning assessment that helps all students understand all class subjects and provides them and their parents/cares with a clear platform on how to make effective improvements. Spiller (2009) argued that, providing students and parents with assessment feedback is consistently and strongly related to improved achievement than other assessment behavior.



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Spiller, D. (2009). Assessment: Feedback to promote student learning. Manuscript submitted for publication, The University of Waikato, The University of Waikato, Hamilton, New Zealand.

NSW Education Standards Authority (2012). Kindergarten – Year 6 assessment strategies. From:

Australian Federation, (2017). Assessment modes and practices. From:

UNSW Australia (2015).Assessment Toolkit: Giving Assessment Feedback. From:



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Effect of enzyme concentration on the initial rate of an enzyme-controlled reaction


Enzymes are types of proteins necessary for catalyzing chemical reactions in the body. Enzymes are synthesis just as ribosomes do other proteins synthesis in the cell.  Enzymes are substrate specific and therefore react with specific substrates to enhance the rate of chemical reactions in cells (Karbach, Veit, & Ewe, 2009). Chemical reactions would otherwise be slower in the cells were it not for the action of enzymes and thus inhibiting basic human functions like breathing and digestion.

Trypsin is an enzyme that acts on proteins; it is secreted in the inactive form of trypsinogen from the pancreas into the small intestines. It acts on protein substrates resulting in the formation of amino acids and peptides (Hughes, Cohen, Arvan, & Seamonds, 2009).  Trypsin just as any other enzyme is pH specific and therefore requires specific levels of alkalinity and acidity for optimum action.

In the context of this experiment, the main objective was to determine how enzyme concentration changes the effectiveness of trypsin enzyme.

Health and safety

1% to 5% of Trypsin solution is an irritant and should be handled with care. If the solution splashes on the skin, it should be washed using plenty water as quick as possible. Eye protection should also be worn by all students in the laboratory to ensure their eyes are safe from the solution. In any case, the solution gets in any students eye; it should be reported immediately to the laboratory instructor (Poupon, Poupon, Grosdemouge, & Erlinger, 2009). Extra caution also needs to be taken when handling the enzyme’s solution; the enzyme may be kept in a refrigerator, but students should ensure that the experiment is completed within one session as the activity of protease enzymes decline with time.

Silver halides are low hazard materials and therefore can be used without considering extra caution, it should, however, be noted that old-fashioned photographic film is used for this experiment as the modern films do not use gelatin coatings (Zhang & Vardhanabhuti, 2014).


Trypsin (an example of protease) acts on milk protein (casein), the action results in breaking down of the milk from the opaque white colour into a clear solution (Poupon, Poupon, Grosdemouge, & Erlinger, 2009). The reaction can, therefore, be monitored by a colorimeter or a spectrometer as the clear solution allows for easy monitoring. The reaction apparatus can be arranged as shown in fig 1.0.

Fig 1.0: Apparatus for monitoring the rate of reaction.




1% trypsin solution was taken and diluted using distilled water into various test solutions of 0.2%, 0.4%, 0.6% and 0.8% respectively. The solutions were made up to 10 cm3 in boiling tubes and each of the boiling tubes containing solutions labeled using a lab maker. The resultant solutions were recorded in the laboratory notebook. 2 cm3 of trypsin, and 2 cm3 of water were added to the cuvette and used to set the absorbance of the calorimeter/spectrophotometer to zero. A suitable filter/wavelength for analysis of a blue solution was determined from the BIOL4A graph. 2 cm3 of milk powder solution was measured and added to a second cuvette. To the milk solution, 2 cm3 of trypsin solution was added and the solution quickly mixed and placed on the calorimeter/spectrophotometer and the stopwatch started.

The value of absorbance was measured immediately and subsequently at 15 seconds intervals until there was little change in the absorbance. The results were recorded in the table of results and used for further analysis. The procedure was repeated using new cuvettes with different concentration of trypsin from 1% to 0.2% and the results recorded in the table of results.


Trypsin Concentration /% Absorbance
0 15 30 45 60 75 90 105
1 0 3.5 5.5 6 7.8 8.8 9.4 9.7
0.8 0 2.7 4.5 5.8 6.8 7.5 8.2 8.7
0.6 0 1.7 3 4 5 5.8 6.5 7
0.4 0 1 1.7 2.5 3 3.8 4 4.5
0.2 0 0.5 1 1 1.7 2 2 2.3
0 0 0 0 0 0 0 0 0


Fig 2.0: A plot of Absorbance Versus Time

Fig 3.0: A plot of initial rate of reaction versus enzyme concentration.

For a comparison of the rates of reaction of the five sets of reaction, the rates at the beginning of the reaction were determined. This is because once the reaction begins, there is a variation of substrate concentration as there is a conversion of the substrate to the product at different rates. The differences in reaction rates captured from the beginning are therefore important indicators of difference in enzyme reactions caused by the difference in the concentrations of the enzymes (Hughes, Cohen, Arvan, & Seamonds, 2009). The initial rate of enzyme reaction was calculated from the slope of the curves of the five different reactions at 30 seconds from the beginning of the reaction. An ideal case should, however, be as close to zero as possible which is not practical to implement. A second graph was then drawn with the initial rate of reaction plotted against the concentration of the enzyme in the reaction.

Fig 4.0: Absorbance Versus the wavelength

A plot of absorbance versus wavelength results in an absorption spectrum of a sample under investigation. It is useful in the identification of unknown samples because samples have unique characteristic absorption spectra.  The spectra shown in fig 4.0 was used for this experiment, the enzyme peaked at an approximate wavelgth of 600 nm.


Trypsin concentration was the independent variable in the experiment while the rate of reaction (absorbance) was the dependent variable in this experiment. A rapid reaction occurs between the milk substrate and the enzyme resulting in the quick depletion of the milk and thus formation of a clear solution. At the beginning of the experiment, controlled variables such as substrate concentrations are normally the same at all levels for the independent variable thus making it easier for comparisons to be done. Absorbance values for the experiment may be higher than the actual values due to the presence of systematic errors. Other factors that may affect the rate of an enzyme-catalyzed reaction include the pH (Karbach, Veit, & Ewe, 2009). A change in pH of the reaction results in changes shape and size of the active site of the enzyme thus resulting in a variation in the rate of enzymatically catalyzed reactions. Enzymes thus work best at their optimum pH values.

From the graph, it is clear that a linear relationship exists between the initial rate of reaction and enzyme concentration that is the reaction rate is directly proportional to the concentration of the enzyme. This is because doubling or increasing the number of enzymes in a reaction increases the active sites available for slotting in of the substrate (Poupon, Poupon, Grosdemouge, & Erlinger, 2009). It should, however, be noted that the increase of enzyme concentration can be inhabited by the unavailability of the substrates.

Other factors that may inhibit the rate of enzyme catalyzed reactions include; the concentration of the substrate, the pH, temperature among other factors. An increase in substrate concentration also results in an increase in the rate of enzyme catalyzed reaction; this is, however, subject to the concentration of the enzyme and other factors. Temperature is also a vital component for optimum functioning of the enzymes (Zhang & Vardhanabhuti, 2014). Enzymes work best at specific temperatures, an increase in temperature beyond these temperatures denatures the enzymes and thus result in reduced rates of enzyme controlled reactions. A decrease in temperature below the specified temperature for enzyme operation results in inactivation of enzymes and thus slow enzyme reactions.

Enzymes work in specific pH values beyond which they are damaged. For example protease in the stomachs work under acidic environments and are damaged in alkaline conditions.


Enzymes are proteins and are useful in chemical reactions in the body as they lower the activation energies of reactions thus catalyzing the reactions. All chemical reactions in the body including anabolic and catabolic reactions are enzyme controlled. Enzymes are site specific and therefore are unique in structure and shape thus binds only to specific sites of the substrate resulting in the formation of an enzyme-substrate complex. Substrates reshape the size and shapes of binding thus resulting in perfect binding of the substrates and the enzymes.

Factors that affect the size and shape of the active site such as higher temperatures than the enzymes optimum temperature, high and low pH values, the presence of non-competitive inhibitor reduces the enzymes ability of binding with the enzyme and thus its activity (Poupon, Poupon, Grosdemouge, & Erlinger, 2009). The rate of reaction of en enzyme-catalyzed reaction may also be reduced by the presence of competitive inhibitors that reduces the likelihood of the substrates to bind thus reducing the rate of reaction.

Trypsin is an example of protease and thus acts on proteins to form peptides and polypeptides. Trypsin being a protein it works under specific conditions of temperature, pH, and concentrations of body fluids.  In this experiment, the effects of trypsin concentration on the rate of enzyme catalyzed reactions were examined, and the results analyzed as shown in the discussion section above (Karbach, Veit, & Ewe, 2009). Trypsin concentration affects the rate of digestion of proteins that is an increase in trypsin results in an increase in the initial rate of enzyme catalyzed reactions. It is, however, wise noting that the rate of reaction of an enzyme-catalyzed reaction is inhibited by other factors such as the concentration of the substrates.

The main objective of the experiment was achieved as the initial rate of reaction of the enzyme was compared to the concentration of the enzyme (Hughes, Cohen, Arvan, & Seamonds, 2009). A linear relationship was observed which is true for the initial.




Hughes, W., Cohen, S., Arvan, D., & Seamonds, B. (2009). The Effect of the Alkaline Tide on Serum-Ionized Calcium Concentration in Man. Digestion15(3), 175-181.

Karbach, U., Veit, J., & Ewe, K. (2009). Postprandial Cholylglycine Serum Concentration and Extent of Heal Inflammation or Resection in Crohn’s Disease. Digestion34(3), 202-206.

Poupon, R., Poupon, R., Grosdemouge, M., & Erlinger, S. (2009). Effect of Portacaval Shunt on Serum Bile Acid Concentration in Patients with Cirrhosis. Digestion16(1-2), 138-145.

Zhang, S. & Vardhanabhuti, B. (2014). Effect of initial protein concentration and pH on in vitro gastric digestion of heated whey proteins. Food Chemistry145, 473-480.


Ventilator-Associated Pneumonia











Ventilator-Associated Pneumonia


Institutional Affiliations










Table of Contents

Introduction. 3

Definition of Ventilator Associated Pneumonia (VAP). 3

The Disadvantages and Effects of Ventilator Associated Pneumonia (VAP). 3

Etiology: Causes of the Disease. 4

Causes of Ventilator Associated Pneumonia (VAP). 4

Signs and Symptoms of VAP. 6

Diagnosis of VAP. 7

Radiologic Diagnosis. 9

Clinical Method. 10

Microbiologic Diagnosis. 11

Pathophysiology: As a Result of the Disease or Abnormality. 12

Review of the Pathogenesis of ICU-Related VAP. 12

Review of the Epidemiology of VAP; Focusing on Modifiable Risk Factors. 14

Treatments: Specific Respiratory Treatments. 17

Evidence-Based VAP Prevention Strategies, CDC Guidelines and VAP Prevention Bundles. 17

Surveillance for Ventilator-Associated Events (VAE) and VAP, and the Rationale for the VAE/VAP Surveillance Definition Algorithm.. 19

Prognosis: Progress or Outcome of the Disease. 20

Conclusion. 21

References. 22





Ventilator-Associated Pneumonia


Definition of Ventilator Associated Pneumonia (VAP)

Pneumonia is a respiratory disease that affects the lungs and can be contagious based on the causes. The disease can either be viral or bacterial in nature. However, most studies have concentrated on the bacterial causes considering that the viral causes have not been fully conclusive. According to the Association of for Professionals in Infection Control and Epidemiology, APIC (2009), Pneumonia accounts for between 11 and 15 percent of all hospital acquired infections in the United States. It also accounts for 24 percent of all the infections acquired from the coronary unit and 27 percent for the ones resulting from medial intensive care unit (ICU). One therapy used in the treatment of Pneumonia is the Mechanical ventilations (MV). However, the therapy is not without medical complications and one of them is the Ventilator-associated Pneumonia (VAP). Ventilator-associated pneumonia is understood as a type of pneumonic complications mostly occurring after 48 hours following a tracheotomy or endotracheal intubation on a patient (Kalanuria, Zai, & Mirski, 2014). In this paper, the discussion will revolve around the VAP including its aetiology, pathophysiology, treatment/prevention, and prognosis.

The Disadvantages and Effects of Ventilator Associated Pneumonia (VAP)

Just like many other medical-related complications, VAP has wide reaching effects, which doubles as disadvantages and they include the following. Patients and families have to foot huge medical and hospitalization bills incurred in the medication and during the hospitalization of the patients (Cason et al., 2007 as cited in O’Keefe-McCarthy, Santiago, & Lau, 2008). Besides the family members, countries suffer from huge economic burdens and especially through the subsidization of the hospital services and medication as well as in the provision of the health insurance covers among the citizens. Also, the patients put under MVs have relatively long stay at the hospital. The situation exacerbates after the patients acquire the VAP since the hospital stay is further stretched. Finally, this medical complication leads to increased mortality and morbidity rates (Klompas et al., 2014).

Etiology: Causes of the Disease

Causes of Ventilator Associated Pneumonia (VAP)

According to some of the previous studies, the occurrence of the ventilator-associated pneumonia can kick off either early or late after a patient is put under the mechanical ventilation process (O’Keefe-McCarthy, Santiago & Lau, 2008). According to Pruitt and Jacobs 2006 (as cited in O’Keefe-McCarthy, Santiago & Lau, 2008), the early-onset VAP develops between 48 and 96 hrs after the intubation. The most common microorganisms associated with the early-onset VAP includes; Moraxell catarrhalis, and Haemophilus influenza. On the other hand, the late VAP will occur more than 5 days after the mechanical ventilation has been performed on the patient.  The common bacteria associated with this category of VAP include; Kebsiella pneumoniae, enterobacter, and Staphylococcus aureus among others (O’Keefe-McCarthy, Santiago, & Lau, 2008). From the above, it is clear that Ventilator-associated pneumonia is classified into two categories, which largely depend on the type of bacteria accessing the lower part of the aero-digestive tract.

It is important to note from the onset, though, that Ventilator-associated pneumonia is a sub-classification of Health acquired pneumonia (APIC, 2009). However, this is only in the instant where a patient has been admitted in the hospital during the mechanical ventilation process. Like many other diseases, the development of VAP is partially contributed to by the presence of a wide range of risk factors. The body should be in a position to fight against diseases though its natural immunity. However, the introduction of foreign objects into the body goes against this principle. VAP arises from mechanical ventilation and, according to O’Keefe-McCarthy, Santiago and Lau (2008); this therapeutic procedure impedes the body and leads to compromised natural immunity of the body to fight against the respiratory infections. In other words, the aspect of introducing a new endotracheal tube deviate the effective cough reflexes, which are very pertinent in protecting the airway against any invasive pathogens. In this case, the endotracheal tube has been considered a major risk factor in the sense that it violates the natural disease resistance mechanisms (Kalanuria, Zai, & Mirski, 2014). It negatively affects the; larynx, glottis, and the cough reflex, which are critical in the respiratory system.

Some studies are in the support of the above findings. According to a panel of experts from the American Thoraic Society (as cited in Sedwick, Lance-Smith, Reeder, & Nardi, 2012), the introduction and positioning of an endotracheal tube increases the chances of the ventilator-associated Pneuomonia complications from 6 to 20 fold among the patients who have been put under the mechanical ventilation therapy. For VAP to occur, however, the microorganisms must have access to the normal sterile lower part aero-digestive tract (Sedwick, Lance-Smith, Reeder & Nardi, 2012). Sedwick, Lance-Smith, Reeder and Nardi (2012), continues to state that most of the seriously ill patients have depressed levels of consciousness and their weakened gag reflex puts them at a relatively higher risk of the microorganisms having quick access to their lower part of the aero-digestive tract.  Although some studies have argued that the development of VAP can be attributed to viral and fungi causes, there are no scientific conclusions. Hence, there some studies are still in progress to ascertain this argument (Deem & Treggari, 2010). In that case, and based on the above discussion, most of VAP cases have been attributed to the bacteria causes. Although, the complication can be either early or late onset, the causes are mainly bacterial-related. The former is caused by antibiotic sensitive bacteria while the latter is mainly as a result of antibiotic resistant pathogens. According to Deem and Treggiari (2010), for the development of the VAP to take place, two processes must take place; bacterial colonisation of the respiratory tract and the aspiration of the contaminated secretions of the lower airway.

Signs and Symptoms of VAP

VAP is a type of pneumonia and hence, from a broader perspective, some the signs and symptoms may be similar to those of patients suffering from pneumonia. However, most of the patients suffering from the ventilator-associated pneumonia will mainly experience the following signs and symptoms. An important point to note is that the signs may present themselves instantly or may develop gradually. Firstly, the patients are highly likely to experience fever, which implies increased body temperatures beyond the normal body temperature range.

Secondly, there is the presence of chills among the VAP patients. This is a situation where the patients experiences extreme cold and subsequent shivering. Chills are largely evident at the onset of an infection and are as result of rapid changes in muscle contraction and relaxation. Pneumonia is as a result of the pulmonary infection, the reasons as to why most of the patients are likely to experience the chills. Although, a chill may present itself as an individual symptom among the patients, there is strong correlation between chills and fever. In this case, PAV tend to experience both of these two symptoms.

Thirdly, some of the patients may also experience a cough as well as the production of the purulent sputum. A cough partly develops as a result of accumulated foreign irritants and mucus build-up in the trachea. As such, it can be regarded as a common reflex action, whose aim is to clear up the above mentioned accumulations and build ups. On the other hand, sputum production refers to the aspect of coughing out the material that is produced in the respiratory tract.

Fourthly, a shortness of breath is another major symptom among the VAP patients. In fact, shortness of breath has largely been associated with lung and heart diseases and VAP is a complication affecting the respiratory system. This is linked to the above-mentioned symptom, which is as a result of mucus build up and the presence of foreign elements in the trachea that eventually, implicate the normal breathing of the patients.

Fifthly, it is not uncommon for the VAP patients to experience thick mucus. As demonstrated in the previous sections, VAP majorly affects the respiratory tract. The mucus membrane is aligned on the trachea implying that most of the mucus processes take place in the aero-digestive tract. As previously demonstrated, the mechanical ventilation and intubation take place in the respiratory tract. Therefore, the development of VAP, which mainly affects the respiratory tract, will have an impact on the mucus formation and excretion processes.

Finally, some of the patients suffering from VAP complication may experience chest pain symptoms. The primary cause of the chest pain is associated with heart’s muscle problems when the muscle is unable to access enough blood, rich in oxygen. From the preceding sections, it is apparent that the patients of VAP will experience decreased oxygenation. Eventually, the blood will be oxygen deficient (Hypoxemia), thereby triggering the problem of chest pain. Furthermore, lung-related problems have been linked to the causes of chest pain and, hence VAP is not an exceptional.

Diagnosis of VAP

To this present day, there is no standard diagnostic criterion that has been recommended for VAP and, hence the diagnostic approach to use is still elusive. In fact, some studies have argued that the detection of nosocomial pneumonia, especially VAP, is very difficult to diagnose (Tablan et al., 2003). The traditional methods that have largely been used in the diagnosis criteria of the VAP include; the combined existence of the development of the purulent sputum, coughing, and existence of fever. The cultures of the sputum and some clinical criteria are sensitive for bacterial pathogens. However, some studies have imputed the ability of the above to diagnose VAP, as they are not specific. The culture of the blood has also not been considered effective in testing the presence of VAP (Tablan, 2003).

However, according to Tablan et al., (2003), some methods of diagnosing pneumonia, which extends to VAP, were proposed back in the year 1992 by a group of investigators. These were considered the standard diagnosis methods for detecting this medical complication. The methods incorporated the aspect of carrying out the bronchoscopic techniques on the patient (Tablan et al., 2003). However, with time more researches have been conducted and have established that using bronchoscopic methods can lead to more complications considering that they are invasive in nature.

According to the Infectious Diseases Society of America (AIDS) and the American Thoracic Society (ATS), the diagnosis of VAP can be made possible through the extraction of some samples from the lower aero-digestive tract, which can then be used for culture and microbiology. According to AIDS and ATS, the samples can be either qualitative or quantitative.

Additionally, based on the guidelines proposed by the Infectious Society of American and the American Thoracic society, the tracheal aspirates can be used for the negative predictive value (Kalanuria, Zai, & Mirski, 2014). Johnson et al., (as cited in Kalanuria, Zai, & Mirski, 2014), offered the description of the clinical diagnosis for VAP as described below. According to authors the psychological, microbiological, clinical, and radiographic evidence are taken into account by the clinical pulmonary infection score (CPIS), which let a numerical value to help predict the existence of the ventilator-associated pneumonia (Munro & Ruggiero, 2014). The score range is between 0 and 12, and the score value of more than 6 indicates a strong correlation with the incidence of ventilator-associated pneumonia. However, despite the existence and application of the CPIS, there are debates revolving around its diagnostic validity (Kalanuria, Zai, & Mirski, 2014). The inter-observer variability in CPIS remains significant regardless of its straightforward computation.

Radiologic Diagnosis

This denotes the aspect of using medical imaging in the detection, such as the X-rays of the chest in the diagnosis process. Previous studies have imputed the possibility of the normal chest radiograph in the diagnosis of the presence of VAP (Munro & Ruggiero, 2014). Some of these studies have argued that the asymmetric pulmonary infiltrates that are consistent with the ventilator-associated pneumonia can result from among other causes such as drug reaction, chemical penumonitis, and pulmonary embolism among others. The total radiographic specificity of a pulmonary opacity consistent with pneumonia stands at between 27 and 35 percent. However, medical researchers are convinced that the high specificity degrees present in some of the radiograph findings can be very critical and effective in the diagnosis of the pneumonia, especially in the case where it is present. Although the radiographic diagnosis criterion has been considered to have specificity percentage of 96, radiographic abnormalities are common (Munro & Ruggiero, 2014).

Clinical Method

The clinical criteria for the diagnosis of the Ventilator-associated pneumonia require the mandatory use of the portable chest radiograph. However, the use of this approach is considered to present specificity and sensitivity challenges. Studies have, additionally, cited low-quality of the films, obtained from the chest X-rays as presenting another compromise to diagnosing the presence of VAP.  What is evident is that the clinical criterion in the diagnosis of VAP has limited diagnostic accuracy. The development of purulent tracheobronchial secretions, leukoytosis, and chest radiograph predicate the presence of suspected Ventilated-associated pneumonia (Kalanuria, Zai, & Mirski, 2014). However, the clinical diagnosis criterion for pneumonia has been limited in the diagnosis of the Ventilator Associated Pneumonia relative to its appropriateness in the diagnosis of community acquired pneumonia. Previous studies have stated that; more diagnostic symptoms have to be used in the combination of the above mentioned three. They further establish that the elimination of one of the above-mentioned clinical variables will reduce the sensitivity and the use of a single variable declines it further. Further, such studies have argued that symptoms such as fever, leukoytosis, and tachycardia, which are common symptoms of VAP, do not qualify as the final specific diagnostic criteria considering that they are present in other medical conditions (Munro & Ruggiero, 2014). Additionally, patients receiving mechanical ventilations are likely to exhibit purulent tracheal bronchial secretions, which in such a case are not caused by the presence of pneumonia. The sensitivity of VAP among the above discussed cluster of patients is more challenging for those patients suffering from Acute Respiratory Disease Sydrome (ARDS) (Center for Disease Control and Prevention, 2014). According to the clinical VAP diagnosis approach, the diagnosis of the nosocomial tracheobronchotis is only validated if there is the presence of leukocytosis, fever, and purulent sptum that has a positive sputum culture. However, in such a case scenario, there has to be the absence of any new lung infliltrate. Nosocomial tracheobronchial has largely been associated with the longer ICU stay and extended time on the ventilator for the patients undergoing the mechanical ventilation. In the case of the clinical criteria diagnosis criterion, the CPIS is largely recommended as compared to the direct therapy. Although it is sensitive, the chest radiography is typically nonspecific. On the other hand, the clinical diagnosis criterion has been used alongside other features in the diagnosis of the ventilator-associated pneumonia. To this point, CPIS has been considered helpful in the diagnosis of VAP. Unfortunately, it has moderate performance and a considerably high degree of inter-observer variability, which compromises its reliability in VAP diagnosis.

Microbiologic Diagnosis

The microbiologic diagnosis criterion has been considered the most appropriate approach in the diagnosis of ventilator-associated pneumonia. This method makes use of invasive techniques, which require the aspect of obtaining samples such as B-PSB, NB-BAL, and B-BAL. The samples are later on evaluated through the use of Gram stain, which uses quantitative cultures (Marti & Ewig, 2011). Based on previous findings, there can also be the use of less invasive suctioning of the trachea (Marti & Ewig, 2011). This way, there is the yielding of valuable ETAs that are later accessed by the bacterial culture and Gram stain, either semi-quantitatively or quantitatively. Gram stain has been considered reliable in the sense that it provides rapid information on the quality of the specificity as well as the number and morphology of the infecting pathogens. The presence of any offending bacteria is made possible by the morphology of that particular bacterium. Also, the presence of a myriad of squamous epithelial cells indicates the presence of oral contamination of the particular specimen (Kalanuria, Zai, & Mirski, 2014). The infections leading to the emergence of the ventilator-associated pneumonia are suspected in the case where the Gram stain is contaminated or colonized by relatively too many bacteria and polymorphonuclear cells (Marti & Ewig, 2011).

However, there is a strong negative predictive value for the presence of VAP in the case where Gram stain of the ETA or sputum has no inflammatory cells and there is non-existence of bacteria. This is primarily because, the fever detected as being the cause of the VAP may have been as a result of another medical conditions. The invasive techniques, B-PSB (10^3 cfu/ml), NB-BAL (10^4 cfu/ml), and B-BAL (10^4 cfu/ml) have presented the standardization criteria in the diagnosis of VAP (Kalanuria, Zai, & Mirski, 2014). Any quantitative cultures, with values ranking below the above stipulated thresholds, imply a colonization or contamination by other exceptions. Most of the laboratory tests make use of the semi-quantitative techniques and there is no single quantitative technique that can be used in the diagnosis of an infection. Most of the laboratory tests make use of the threshold of > (greater or equal to) 10^5 cfu/ml. Any growth of pathogens below the pre-stated threshold is mostly associated with colonization (Kalanuria, Zai, & Mirski, 2014).

Pathophysiology: As a Result of the Disease or Abnormality

Review of the Pathogenesis of ICU-Related VAP

Previous studies have established that the interplay between risk factors and the presence of the endotracheal tube largely contribute to the development of the Ventilator associated pneumonia (Kalanuria, Zai, & Mirski, 2014). As demonstrated in the preceding sections, the onset and development of the ventilator-associated pneumonia is triggered by the invasion of the lung parenchyma and the lower sections of aero-digestive tract by microorganisms. The pathogenesis of VAP, whether nosocomial or ICU acquired, is highly characterized by the invasion and colonization of the oral cavity by aero-digestive pathogens that access the lower sections of the respiratory tract. Most of the patients admitted in the intensive care units often suffer from critical medical conditions and their overall bodies’ natural immunity, to fight against any potential infections, is compromised. One of the factors that have been attributed to the eruption of pneumonia is the inability of the host patient’s inability to fight against any invading microbial pathogens. The reduced state of the immune system has been linked with the interplay of a myriad of multilevel factors.

Ventilator- associated pneumonia accounts for approximately 30 percent of the all the ICU-related infections. VAP has the probability of increasing the hospital stay among the affected patients and may also negatively affect the overall outcome (Klompas, 2014). According to Deem and Treggiari (2010), an argument can be made that relative to the ventilator, the endotracheal tube predisposes the high susceptibility to VAP among the ICU patients. The positioning and regular maintenance of the tube through the glottis increases the chances of developing the VAP (Hess, et al., 2003).

According to Kalanuria, Zai, and Mirski, (2014), bacteria can access the lower respiratory tract in four major ways. Firstly, they can do this by impairing the mucociliary clearance of secretions and the placement of the endotracheal tube has been found to increase this risk considering that it depresses the epiglottic reflexes and also prevents the mucociliary clearance of secretions (Kalanuria, Zai, & Mirski, 2014).  In such cases, the bacteria will travel around the cuff or through the tube in small quantities. What follows is the embolization of the bacteria into the lungs after every other breath.  Secondly, the bacteria can pool and trickle secretions around the cuff, through the micro-aspirations of secretions. Most of the aspirations, among the patient subjects, happen during the night. Risk factors are higher among the hospitalized and ICU patients and especially the ones who have undergone the mechanical ventilation process (Hess, 2003). This is mostly among the patients who have an underlying disease as well as the patients who have been put under sedative drugs, which are common in the Intensive care units. Studies have established that most cases of micro aspirations are linked to high volume-low pressure inflated ETT cuffs (Huff, 2003).  Thirdly, the access can be accelerated during the instances when the intubation is being performed. Aspiration and oropharyngeal secretions are bound to occur during the intubation process (Deem & Treggiari, 2010). Finally, the bacteria access can be triggered by the development of a biofilm lumen in the tube. According to Deem and Treggiari (2010), there is a strong concordance between tracheal-suction samples, obtained from VAP patients, and the biofilm. Further, the study establishes that the biofilm creates a good environment for the proliferation of the bacteria while at the same time acting as a resistant to antibiotics. Eventually, the increase of the bacteria in the aero-digestive tract leads to its colonization. Consequently, the excess secretions, presence of aspirated oesophageal as well as the pools and leaks have relatively high potential of infiltrating the lungs, thereby, causing the Pneumonia and, in this case, the Ventilator Associated Pneumonia (Kalanuria, Zai, & Mirski, 2014).

Review of the Epidemiology of VAP; Focusing on Modifiable Risk Factors

According to O’Keefe-McCarthy, Santiago and Lau (2010), the risk factors linked to the ventilator-associated pneumonia include the ones that can increase the possible aspiration and oral secretions as well as those that impair a patient’s defence system.  Additionally, according to Ablan et al., (2003), the potential risk factors associated with the nosocomial bacteria related pneumonia have been researched in several studies. According to these authors, the risk factors can be categorized into four major groups despite the fact that the populations that were used in the studies varied slightly. These risk factors include the following; firstly, the factors that promotes the colonization of the oropharynx by microorganisms. Secondly, other risk factors include the conditions that favour the aspirations into the reflux or the aero-digestive tract from the gastrointestinal tract. Thirdly, the conditions that require the prolonged dependence on the mechanical ventilatory support and which have potential exposure to respiratory devices that are contaminated or are in constant contact with colonized hands, especially in the case of the healthcare personnel. In this line, there should be more education on ventilator-associated pneumonia (AARC, 2003). Finally, there is a cluster of other factors such as extreme underlying conditions, malnutrition, and the ones that are age-related (Ablan et al., 2003). The risk factors can be either modifiable or non-modifiable. The modifiable risk factors are the ones that can be prevented and are amenable to change since they are within human control, for instance physical inactivity and discharge from the ICU. On the other hand, the non-modifiable risk factors are the ones that are beyond human control and there is nothing that can be done to alter or reduce them, for instance age and sex.

As regards VAP, the modifiable risk factors include the following discussed.  One of the risk factors associated with the ventilator-associated pneumonia is the issue of colonized hands among the healthcare personnel. The issue of “unclean” hands is not uncommon as a lead risk factor to nosocomial and ICU acquired infections. The use of combined interventions is appropriate in the prevention of VAP. For instance, there is a need to use enough staffing, alcohol-based hand sterilizations, and education-based infection-control interventions so as to reduce the VAP incidence levels (APIC, 2009).

Secondly, increased aspiration of microorganisms, which are rich in colonizing flora bacteria, into the lower parts of the aero-digestive tract promote the incidence of VAP. Through the use of subglottic secretions, there is a high probability of reducing the incidence of Ventilator associated pneumonia.

Thirdly, the incidence of VAP is triggered by the bacteria formation during the intubation process and is also largely dependent on the longevity of the mechanical ventilator in the body. The ventilators should be avoided at all costs (Klompas, 2014). There could also be the use of alternative strategies and application of non-invasive methods, Non-invasive positive pressure ventilation, so as to reduce the incidence of the disease.

Fourthly, some studies have cited the formation of the biofilm as one the risk factors that increases the incindence of VAP (Klompas, 2014). The bacterial biofilm is formed on the inner side of the endotracheal tube. Eventually, the accumulation of these bacteria results in resistance to antibiotics. Additionally, they lead to the humoral and cellular defenses and have been attributed to increased recurrence rates of infections. Some of the bacteria that have been linked to the formation of the biofilm include among others the pseudomonas (Klompas, 2014). What follows is the mechanical dislodge of the bacteria through the bronchoscope, airway, and the suction catheters in the trachea. Eventually, this increases the incidence rate of VAP. This incidence rate can be corrected by making use of antimicrobial agents in coating all the intravascular catheters such as in the case with the intubation and mechanical ventilation performed in the respiratory tract. Consequently, this will help mitigate a large number of infections that are device-associated.

Finally, the presence of the Oropharyngeal colonization has linked to VAP incidence. This is caused by the p. Aeruginosa and entric gram-negative bacteria. The Oropharyngeal colonization is positively correlated with the time of admission as well as the length of stay in the ICU (Wunderink & Rello, 2011). In this case, the intonation of the Oropharyngeal colonization can be achieved through the optimal use of the appropriate chlorhexidine therapy and antibiotics.

Treatments: Specific Respiratory Treatments

Evidence-Based VAP Prevention Strategies, CDC Guidelines and VAP Prevention Bundles

A number of strategies have been proposed as mechanisms to helping prevent the incidence of VAP. Most of the VAP prevention strategies focus on the contamination of equipment used, the colonization of the respiratory tract, and aspiration (APIC, 2009). According to Kalanuria, Zai and Mirski (2014), there are five VAP bundles that can be used in the mitigation and improvement of the VAP outcome. Firstly, there is the need to have a daily sedation assessment as well as spontaneous breathing tests, accompanied with possible and effective extubation. Secondly, there is a need to have a deep venous thrombosis prophylaxis. Thirdly, there is a need to avoid the supine head positioning by ensuring the appropriate head elevation. Fourthly, there is a need to use chlorhexidine as a daily oral care (Health Protection Scotland, 2012). Finally, the healthcare personnel should consider the concept of stress ulcer prophylaxis (Sedwick, Lance-Smith, Reeder, & Nardi, 2012). According to O’Keefe-McCarthy, Santiago and Lau (2008), the collective implementation of all the VAP bundles achieves better outcome as compared to the individual application. Eventually, this reduces the incidence of VAP. In connection to the above, there is a need to adopt the following prevention strategies if success is to be achieved.

The first prevention to use is extubation. From the above-discussed risk factors, it is clear that one potential to the increased incidence rates is the time span of the endotracheal tube (APIC, 2009). This is also captured in the five “VAP Bundles”. In this connection, therefore, there is a need to perform daily tests on patients’ weaning to mitigate the higher chances of VAP incidence (O’Keefe-McCarthy, Santiago & Lau, 2009). The second prevention strategy can be obtained from the “VAP Bundles”, which require the proper position of a patient’s head. There is a need to ensure a semirecumbent head positioning for the ventilated patients (APIC, 2009; Deem & Treggiari, 2010). The third highly ranked prevention strategy is to ensure minimized or zero instrumentation of the aero-digestive tract. In other words, the healthcare personnel should try as much to avoid the use of endotrachea tube, which eventually increases the rates of bacteria colonization (APIC, 2009; Deem & Treggiari, 2010). In this connection, APIC 2009, cites the issue of hand hygiene as being a contributor risk factor to VAP incidence. The fourth prevention strategy is the decontamination of the f the oropharynx with topical chlorhexi-dine, which has been cited by APIC, (2009) as well as Deem and Treggiari (2010). This concept is also captured in the VAP bundles. The fifth prevention strategy can be adopted from the article by Deem and Treggiari (2010), who proposes the use of modified designs of the endotracheal tube so as to reduce the issue of biofilm formations. The sixth VAP prevention strategy stems from VAP bundles and has been stressed by Dickinson and Zalewski (2016), and regards the use of antiseptic agents such as chlorhexidine in the daily mouth care. Other proposed prevention approaches include mobility and nutrition, which pertain to reduced time length of bed rest and enteral feeding respectively (APIC, 2009).

Surveillance for Ventilator-Associated Events (VAE) and VAP, and the Rationale for the VAE/VAP Surveillance Definition Algorithm

Due to the challenges experienced in the accurate diagnosis of VAP, the National Healthcare Safety Network (NHSN) came up with new surveillance approach, VAE that includes VAP. VAE is an acronym to Ventilator-Associated-Events. According to the Center for Disease Control and Prevention (2014), VAEs constitutes the combination of objective criteria, which are commonly referred to as the 3-tiers. These include; “deterioration in respiratory status after a period of stability or improvement on the ventilator, evidence of infection or inflammation, and laboratory evidence of respiratory infection” (Center for Disease Control and Prevention, 2014, p. 18).

The surveillance definition algorithm of VAE, as proposed by the NHSN, has a definition rationale that utilizes the following five steps. The first step focuses on the Ventilator-Associated Events (VAE) Surveillance Algorithm. It concentrates on the patient stability improvement while in the ventilator, oxygenation, temperature variations, antimicrobial agents, purulent respiratory secretions, and positive cultures. The second stage revolves around issues on the Ventilator-Associated Condition (VAC). It focuses on the baseline improvement of a patient stability on the ventilator. This should be “defined by more than or equal to 2 calendar days of stable daily decreasing minimums*FiO2 or PEEP values” (Center for Disease Control and Prevention, 2014, p. 18). Different indicators of worsening oxygenation must also be assessed on a daily basis. In the third step, the focus is on the Infection-related Ventilator-Associated Complications (IVAC), which requires the patient to have met the VAC criteria.  Worsening oxygenation criteria, temperature variations, and antimicrobial agents must be taken into consideration during this stage. The fourth step focuses on the Possible Ventilator-Associated Pneumonia (VAP), which necessitates the client to meet both the VAC and IVAC criteria. Additionally, factors relating to worsening oxygenation and purulent respiratory must be taken into account. Alternatively, positive cultures can be used in the place of the purulent respiratory. The final step relates to the Probable Ventilator-Associated Pneumonia (VAP) and requires the patient to have met the VAC and IVAC criteria. Additionally, there has to be the assessment of the worsening oxygenation criteria as well as one of a host of other factors such as the positive fleural fluid culture; positive lung histopathology; positive diagnostic test for aero digestive tract secretions; or positive culture of, lung tissue and protected specimen brush among others.

As opposed to the traditionally used VAP diagnostic approaches, which lack accuracy, the new VAE surveillance algorithm definition is able to address the diagnosis issues. The suspected patient is put under the five different stages that take into account all the possible criteria used in the diagnosis process.

Prognosis: Progress or Outcome of the Disease

Previous studies have demonstrated that VAP has continued to be major medical complication increasing the morbidity and mortality rates among the critically ill patients (Stevens, 2014). Major developments are being made regarding this disease including coming up with appropriate diagnostic methods such as the one adopted by the NHSN, VAE/VAP surveillance definition. Eventually, this implies that treatment will be offered on evidence-based diagnosis that goes beyond the traditional and inaccurate VAP diagnosis such the clinical, radiology, and microbiologic approaches. Besides the increased mortality rates, there are high costs incurred among the VAP patients to cover for the mechanical ventilation and intubation. Additionally, the patients are likely to suffer from lung-induced injuries as well discomfort especially in cases where there is delayed removal of the mechanical ventilator. Fourthly, there could be medical negligence during the mechanical ventilation and intubation process and this may lead to ventilatory muscle fatigue. Finally, there is likelihood of extended length of hospital and ICU stay among the patients suffering from ventilator-associated pneumonia (Stevens, 2014).


Conclusively, the above discussion has established that ventilator-associated pneumonia accounts for a large number of mortality and morbidity rates in the United States.  Early onset VAP is acquired within the first 48-96 hours after mechanical ventilation or intubation. On the other hand, late onset VAP sets in several days after the mechanical ventilation or intubation. This medical complication has several negative implications, which doubles as disadvantages. The primary cause of VAP is mechanical ventilation and intubation. Traditionally, there has been no accurate diagnosis for VAP and the medical fraternity has relied on the radiology, clinical, and microbiological criteria. There are four different mechanisms through which the development of the ICU acquired VAP can occur. However, there are some modifiable risk factors that can help mitigate the incidence of VAP, if properly controlled. These are the risk factors that are within the control of the patients and the healthcare providers. Eventually, these risk factors have some connection with some of the VAP prevention strategies that can be used in the mitigation or total elimination of the disease’s incidence. The lack of reliable and accurate VAP diagnosis criteria has necessitated the development of a new diagnosis approach, ventilator-associated events (VAE). The new criterion follows a surveillance definition algorithm that incorporates five steps and three tiers. The adoption of the new diagnosis criterion helps incorporates different VAP-related symptoms, thereby ensuring diagnosis specificity.   Huge costs, injuries on the respiratory tract, increased mortality rates, and elongated hospital stays are some of the outcomes of VAP.


AARC. (2003). Care of the ventilator circuit and its relation to ventilator-associated pneumonia. AARC Evidence-Based Clinical Practice Guidelines, 48(9), 869-879.

APIC. (2009). Guide to the elimination of ventilator-associated pneumonia. K Street, NW: APIC.

Center for Disease Control and Prevention. (2014). Ventilator-Associated-Event. Device Associted Module, 10, 1-46.

Deem, S & Treggiari, M. M. (2010). New endotracheal tubes designed to prevent ventilator  associated pneumonia : Do they make a difference?. Respiratory Care, 55(8), 1046-1055.

Dickinson, S & Zalewski, C. A. (2016). Oral care during mechanical ventilation-critical for VAP prevention. Society of Critical Care Medicine, 1-4.         

Health Protection Scotland (2012). What are the key prevention and control recommendations to inform a minimising ventilator associated pneumonia (VAP) quality improvement tool?, National Services Scotland, 1-12.

Hess, D. R., Kallstrom, T. J., Mottram, C. D., Myers, R., Sorenson, H. M., & Vines, D. L. (2003). AARC evidence-based clinical practice guidelines: Care of the ventilator circuit and its relation-associated pneumonia. Respiratory Care, 48(9), 869-879.

Kalanuria, A. A., Zai, W., & Mirski, M. (2014). Ventilator-associated pneumonia in ICU. Critical Care, 1-8.

Klompas, et al. (2014). Strategies to prevent ventilation-associated pneumonia in acute care hosptials: 2014 update. Infection Control and Hospital Epidemiology, 35(8), 1-23.

Marti, A. T., & Ewig, S. (2011). Nosocomial and ventilator-associated pneumonia. Sheffield: European Respiratory Society.

Munro, N & Ruggiero, M. (2014). Ventilator associated pneumonia bundle. American Association of Critical-Care Nurses, 25(2), 163-175.

O’Keefe-McCarthy, S., Santiago C., & Lau, G. (2008). Ventilator-associated pneumonia bundled strategies: An evidence-based practice. World Views on Evidence-Based Nursing, 5(4), 193-204.

Tablan, O. C., Anderson, L. J., Besser, R. Bridges, C., & Hajjeh, R. (2003). Recommendations of CDC and the healthcare infection control practices advisory Committee. Guidelines to Preventing Healthcare Associated Pneumonia, 1-179.

Sedwick, M. B., Lance-Smith, M., Reeder, S. J., & Nardi, J. (2012). Using evidence-based practice to prevent ventilator-associated pneumonia. Critical Care Nurse, 32(4), 41-51.

Stevens, J. P., Silva, G., Gillis, J., Novack, V., Talmor, D., Klompas, M., & Howell, M. D. (2014). Automated surveillance for ventilator-associated pneumonia. CHEST, 146(6), 1612-1618.

Wunderink, R. G., & Rello, J. (2001). Ventilator-Associated Pneumonia. Boston, MA: Springer US.




Reflective writing

Financial management in library environment

Academic libraries in the United States have operated on inadequate budgets especially for the last ten years. Acquisition and maintenance of new technology, storage of electronic information, high cost of library materials and facilities has caused a strain on library financial management. Financial management models vary from one library to another depending on the nature of the institution (Rader, 2000). It could be public or private. The libraries are also operated under different budgetary regulations. Libraries are characterised with a wide range of costs to cater for. The currency of library materials keeps changing with time. For instance research studies recommend that source materials should be dated within the past few years. This consequently means that the libraries have to be restocked regularly with the most current materials ranging from electronic sources to shelve books.

Research shows that libraries in the US have not realised growth in the past three decades due to the impact of the inflation cost that has been associated with library materials. The libraries’ financial managers have been forced to cut on the budget by cutting on the operating expenses. The basic library budget covers material costs and personnel expenses only. A small proportion of the budget is allocated to maintenance of the building structures, library equipment and technology. In order to stay at par with the currency of the library materials, their financial managers resort to fundraising. Many libraries in the United States have fundraised to support library operations. Many University libraries have a development program through which fundraising can be made. Universities that provide doctorate grants are more likely to resort to fundraising for their libraries. However, even the smaller institutions that do not provide doctorates programs and grants are quickly pursuing fundraising opportunities (Rader, 2000).

Accounting for Librarians- Evidence Based Practice

The article,”Evidence based library and information practice”,  states that it is not necessary to review evidence-based practice when one is writing for the Evidence based library and information practice. Some researchers insist that it is obvious for librarians who deal with medical information to use the paradigm of evidence based practice in their profession (Brophy, 2007). I agree with this argument because the medical sector is one of the most dynamic fields .This means that the professionals in that field have to keep up dated with the trending factors .Medical professionals have to be guided by evidence-based practice in their decision making for diagnosis and treatment (Holt, 2002). Evidence-based librarianship aims at enhancing library practice (Brophy, 2007). This is made possible when librarians use the best evidence available at their disposal together with the pragmatic perspective that is acquired from librarianship experience. Evidence-based librarianship allows librarians to use the most rigorous forms of evidence in decision making. The strength of the article is revealed in its acknowledgement of the importance of using more rigorous evidence. However, the article emphasizes on medical evidence .Don’t other fields need to be associated with complete and rigorous evidence?


Marketing & Strategic Engagement with End Users

In the world of information, end users have to know about the most current information. They also need to be aware of the procedures that are appropriate for handling new information as it comes in. Librarians are required to handle advanced information technology, altered organisation cultures and staying updated with virtual counterparts. They have to devise new ways of attending to end users. Librarians need to be aware of the cultural similarities and disparities in the clients (Reeves & Tillmanns, 2012). This ensures that they learn new knowledge, skills and techniques on a regular basis. Currently, the knowledge and skills that people acquire are bound to change with time. Knowledge that is acquired today may be replaced with another the next minute or tomorrow. Acquisition of information entails a continuous cycle in which end users change from a position of uncertainty to certainty (Watson-Boone, 2000). Information professionals have to continue learning in order to keep up with newer trends. This is true for Librarianship because the librarians are required to provide access to accurate meaning of information to the end users.

New librarians have to practice the theories they learn and apply the acquired skills and knowledge in order to establish their trustworthiness to the end users of the information they deliver. With time, they are able to transform their experiences into knowledge, attitudes skills, values, beliefs and attitudes. The professionals in the information field are able to add empirical knowledge to practice hence they are able to market themselves to end users and engage with them (Watson-Boone, 2000).












Brophy, P. (2007). Narrative based practice. Evidence based library and information          practice, 2(1), 149-158.

Eldredge, J. (2006). Evidence-based librarianship: the EBL process. Library hi tech, 24(3),            341-354.

Holt, G. (2002). God–and the devil–are in the details. The Bottom Line, 15(4).

Rader, H. B. (2000). Fundraising in academic libraries: the United States experience. The Bottom             Line, 13(2), 93-99.

Reeves, M., Love, C., & Tillmanns, P. (2012). Your strategy needs a strategy. Harvard     Business Review, 90(9), 76-83.

Watson-Boone, R. (2000). Academic librarians as practitioner-researchers. The Journal of academic librarianship, 26(2), 85-93.











Trust and Trustees (Unmarried Partners and Property Ownership)

How Edward Could Claim the Extra £250,000


It is a common phenomenon to find couples living together living together for an indefinite period of time before they can marry. Some of these couples will end up not marrying even after the long time they have spent living together. However, our main concern is about property ownership and division when these couples separate or fail to marry. It should be understood that despite the time duration taken by these couples while leaving together, the law still treats every individual as a separate individuals when matters of property arises (News, 2013). This therefore means that these people lack guaranteed rights and responsibilities when their relationship comes to an end. It is therefore advisable that people be extra keen when buying property either jointly or on their own while in relationships to avoid problems when it comes to claiming and sharing such properties incase their relationship ends.

The following is an outline on what Edward (a client having problems on sharing of property after they broke up his spouse) could do while observing some set rules and regulations while making a claim on proceedings of property sold by his spouse. Edward’s case is that type where both spouses contributed towards acquisition of the property but only one of them is the owner. The situation further gets complicated when Lucy marries another person and they proceed to purchase some property which they jointly register it in their names. At the same time, Lucy is experiencing some financial problems which she informs Edward when he claims for more cash from the proceeds.

Edward has the right to claim a share in the proceeds obtained from selling the house despite the fact that he is not a joint owner of the property. This is following the fact that Edward contributed in one away or the other during the bringing up of that house. We learn that him being a self-employed builder he had to sacrifice his time from the beginning of 2012 to the end of 2013 while constructing the house. He additionally pent £200,000 of his savings for all costs incurred during the construction period. After this he continues contributing equally to all household expenses.

The general rule on property division demands that property in ownership of one spouse, in a cohabiting relationship, is not subject to division with the other spouse incase the two part ways. This is basing on the fact that cohabiting couples are treated as separate individuals. The individual whose name this property was registered retains full ownership of the property. However, an allowance s provided when the other partner may have contributed financially like paying for mortgages, renovations or took part in its purchase. In this case any formal or informal agreements between these two partners on how the property was to be shared are used. If, in any case, these agreements show that the property was intended to be owned jointly, then it is the mandate of these spouses to make arrangements on how they will share their property. The other partner could be forced to pay the amount the other partner contributed towards the purchase or maintenance of the property. For Edwards’s case, Lucy observes these by paying him back his £200,000 plus an additional £50,000 for as compensation for resources lost during the construction period. This does not go well with Edward who feels that he should have received half of all the cash obtained from selling the property, something I agree on basing on some reasons (Unmarried Couples Rights, 2016).

The law of equity is one way of claiming fairness in division of property pertaining unmarried spouses when they terminate their relationship. Through the law of equity, a spouse is offered various special exceptions to rules concerning property sharing cohabiting couples with one spouse in ownership of the property. All these exceptions are derived from unjust enrichment which is a claim filed by one of the spouses claiming unfair division of property after their break up. It is through this unjust enrichment that the other spouse could demand for additional compensation or equal sharing of property previously owned by the other spouse. However, there are several things to be observed before claiming an unjust enrichment against another spouse (Neyers, McInnes, & Pitel, 2004).

There are various things to be observed when claiming an unjust enrichment against your spouse. For one to make a successful unjust enrichment claim against the other spouse, they should be able to show three of the following to a court of law. One, the spouse should show a gain obtained by the other spouse from the property or proceeds of the property. Secondly, he or she should also be able to show a loss or losses incurred by him or her on the property. They should also be able to show that both clients contributed in one way or the other towards the property. And lastly they should be in a position to justify that there is no legal reason for the other spouse to enjoy gains from the property or losses pertaining to the property. After ensuring that the other spouse’s circumstances meet the above mentioned condition, he or she can then comfortably claim an unjust enrichment against their spouse (Bits of Law, 2015).

Proving unjust enrichment claim against could at times be difficulty when there is proven agreement or universal partnership between the partners concerning ownership of the property. Like in the case of Edward, Lucy and Edward had not entered into entered into any form of agreement concerning property division and ownership. During registration of their house, Lucy comfortably registers it in her name with no restrictions. However, Edward is still entitled to claim the extra £250,000 from proceeds obtained after Lucy sold the house. This could be achieved basing on the following reasons (Neyers et al., 2004).

To start with, Lucy and Edward are like married couples given the fact that they had stayed together for more than two years. This is evidenced by the fact that they had been staying earlier own together before they developed the idea about getting a home, which then took two years. Therefore, basing on Family Law Act of British common law, these two individuals were like married couples and share legal rights just like other married couples. Among these rights include; the right to 50% share of property, debts, and even inheritance of a spouse’s property. It should however be understood that property acquired before they started having a relationship are not subject to this unless the other spouse contributed in ways of skill, finances or any other way (News, 2013).

Basing on the provisions of the family law act, Edward is entitled to a fifty percent share of proceeds of sale of their property. It is therefore a rightful thing for him to demand an extra £250,000 in addition to the earlier amount. The property in question was also obtained when the two were in a relationship. This is in full support of Edward’s claim on the fifty percent share in the house despite the fact that it was registered in the name of Lucy. Furthermore both the two individuals contributed in equal amounts towards the house. Lucy was responsible for purchasing land on which the house was house was set up while Edward was responsible for its construction, each spent £200,000.

The common law also offers Edward the chance to claim damages suffered after the sale of the house. For instance, Edward used his savings in the construction of the house. He also quit his job for two good years, which was an agreement between the two, in order to foresee the building of their house. However, when it comes to selling this property, Lucy fails to consult him, goes on to sell the building and does the unimaginable by giving Edward a quarter of the proceeds from the sale of the building. Compensation of £50, 000 is not sufficient for compensations for time lost and profit during the two years Edward did not report to work (Papworth, 2013).

A court of law could make various orders depending on claims of spouses presented before them. Taking Edward’s case as an example, the court could order compensation of losses accrued during the time of construction resulting from the sale of property. This would mean that Edward might get the extra £250,000 he is demanding for depending on agreements or conditions the two had. The court could also do the unimaginable by demanding that Lucy builds Edward a new and similar house on land similar to that on which the two had constructed their building. This however, would be the hardest to be achieved given the fact that Lucy is currently experiencing financial constraints.

Injunctions could another option offered by the court of law. However, Edward will have to meet several requirements before injunctions to stop operations pertaining to the sale of the house. With these injunctions, Lucy would be barred from completing or engaging in activities related to the sale of the house, finalizing buying of her new house, and even clearing her debts using proceeds from the sale of the house. For Edward to succeed in obtaining an injunction against Lucy, he should be able to justify to the court that his claim is a serious question to be tried. More so he should prove that compensation offered by his spouse is not adequate to cover all the losses suffered (Anderson, 2013). He should therefore insist and with evidence that during the two years he was out of work he lost a lot of money that is not close to the £50,000 offered by Lucy as his compensation.

There are several types of injunctions that could be considered by a court of law during the hearing of Edward’s case. One such injunction would be search orders, which basically is an interim but mandatory injunction aimed at preserving evidence from destruction by the defendant. This type of an injunction is exercised without notice and could be used to stop any transactions while holding evidence for the case before Edward arrives from China. The other type of injunction that could be applied is the freezing injunction. This is also applied without notice with the main aim being to stop the defendant from getting rid of money or assets before judgment is made (Freezing orders, 2016). For Edward’s case, this could be a boost given the fact that Lucy is married at the moment and could be tempted to transfer the remaining cash to his husbands account in order to deny or claim spending it on all expenses incurred by her businesses.

The law holds that property owned by one spouse is subject to division if it was acquired by spouses who had constructive trust. Constructive trust could include common intentions for benefit from the property, direct contributions to the property, indirect contributions, and conduct developed in the course of their stay. In this scenario Edward is only required to express the constructive interest behind his claim. One way of justifying this would include providing evidence on receipts, invoices and any transactions done during the construction of their house. The other would support offered during the process of buying the piece of land and registration in the name of Lucy. Lastly the claim on constructive trust may be developed on the fact that the two agreed to build a home for themselves and continued contributing on household requirements in equal capacities, a proof for they both shared common intentions for benefit from the property (Unmarried Couples Rights, 2016).

Liability of strangers is crucial when it comes to matters of property ownership and breach of trust. The same could also be used by Edward in his pursue for an additional pay from proceeds obtained on the sale of the house. As we know, Jamie is a stranger in this case and takes part in buying a house with Lucy from funds obtained from the sale of the other house. Through the law, there are two grounds on which strangers could be held liable for their actions with trustees. Such grounds include; involving themselves in deals with property from breach of contract or having an involvement with dishonest assistance in association with a breach of trust. In this case, Jamie could qualify for liability on grounds of his involvement with property breach of trust. (Hudson, 2007).

I this case, Jamie should be held liable for involvement in the purchase of their new home. Bearing in mind that Edward had not been consulted about on the sale of their previous home Jamie still allows Lucy to go ahead and purchase a new home. It makes the matters worse by having this property registered in joint ownership of Jamie and Lucy, something that was not the case during Edward’s time. It therefore means that Edward has been bared out of the new property acquired by Lucy from money obtained from the sale of their previous house. The fact that Jamie has knowledge of the breach of trust between Lucy and Edward qualifies him to be personally liable for the loss of property or trust between the two (Bits of law, 2015). Jamie might therefore take part in refunding Edward basing on this claim.

Jamie is an opportunist who like other opportunists would not allow golden chances to pass them. He quickly seizes the opportunity when it presents itself that Lucy was willing to sell their previous house and buy a new one. He avoids questioning about Edward (the person responsible for building the house) on whether he could claim extra cash when offered the £250,000. What Jamie did was convenience Lucy and has the new house registered in both their names despite the fact that he did not contribute even a coin. Ironically, Edward who contributed equally with Lucy in the older house was never involved in the ownership of the property. Basing on this, Lucy and Jamie owe Edward.

Trustees are endowed with the responsibility of protecting all property entrusted to their care and distributing all benefits obtained from such properties. Trustees are not expected to use the trust property for their sole benefit or any other person who is not a beneficiary. They are also not expected to fail to take action when breach of trust is being committed by another person among other things. A trustee may therefore be held liable in the case where the trustee goes against their expectations, neglect their duties or walk away with the property without consent of the other (Hudson, 2007). The same case applies to Lucy who is left in the ownership of a house when Edward leaves for China.

Lucy should be held liable for breach of trust following her acts of neglecting her duties and going against her expectations. Breach of trust is observed when Lucy sells their house without the consent of Edward and yet they both contributed equally towards the house and have been in a relationship for more than two years. She also goes ahead to use the proceeds obtained for her sole gains. She uses some of the cash obtained for paying losses and expenses of her business (a significant amount of about £225,000 payment to her bank). While referring to the duties of a trustee it is against the law for a trustee to walk away with property without informing the other party or using it for self-gains (Hudson, 2007).

Including Jamie as a co-owner of the newly acquired house is against duties and expectations of a trustee. Any trustee is not expected to use trust property for the benefit of other people who are not beneficiaries to the property. Jamie is a stranger in this case, but he might have convinced Lucy towards the purchase of the new building worse enough registering it in their names. Sixty percent of proceeds from the sale of the house (£600,000) are used in the purchase of the new house. By doing so, Lucy goes against the law on the duties of and expectations of a trustee. She should therefore be held liable for breach of trust between her and Edward and be responsible for losses encountered by Edward (Hudson, 2007).

Any person occupying a fiduciary position is expected to act in good faith always. They are therefore not expected to generate profit or benefits for his or her self or a third person without the consent of their informed principal. Failure to observe this may land this individual into liabilities of fiduciaries which are similar to those of trustees. The individual my then be held accountable of all actions committed and any resulting impacts to the other part. If there may be losses suffered by the other part from such actions, he or she may be asked to compensate them (Hudson, 2007).

Lucy fails to meet expectations of a person holding fiduciary position. She puts her self-interest before everything during the sale of their house. As observed in early scenarios she does not involve Edward during the sale of their house and her inclusion of Jamie, a second party, when purchasing the other house. Her actions of using some of the proceeds obtained to pay some of her company’s losses and liabilities are also against the fiduciary duties (Hudson, 2007).


It is apparent that Edward is right to claim an additional £250,000 payment from Lucy of the proceeds basing on some if not all considerations aforementioned above. We learn that Lucy during the sale of her older home and purchase of the new one violated some rules and regulations regarding property ownership and sharing. She failed to observe some critical steps like informing Edward before selling their property, one of the contributors of breach of trust between them. Her ignorance on rules governing property ownership among cohabiting couples that have stayed for more than two years together could also have contributed significantly. This might have been the reason as to why she offers Edward a quarter of the proceeds rather than half as stipulated by the Common Law of British Columbia.

From my point of view, Edward is entitled to an extra £250,000 to complete the fifty percent right in division of property by married couples. The same rule applies to couples who have stayed more than two years together even when not married. All is required of him is filing a claim to demand for this. He could also claim unjust enrichment against Lucy for her acts that resulted into unfair division of their property. Through his lawyer, Edward might claim compensation from Lucy on the basis of breach of trust between him and Lucy through fiduciary and trustee liabilities. Liabilities to strangers (which he would use against Jamie) could also offer an upper hand in Edward’s claim.

Division of Family Home in England and Wales for Unmarried Cohabiting Couples

A man and woman living together in a stable sexual relationship but not yet married are often referred to as c law cohabiting spouses. These spouses as we know have limited laws protecting them in terms of property ownership, liabilities, and rights. However, when it comes to England and Wales these spouses are viewed in a different perspective. In England and Wales these spouses are protected by the common law of British Columbia and hence their name common law spouses. This rule stipulates that couples who live together for at least two years also have same legal rights like those who are married. Thanks to the efforts that resulted from uncertainties on what really qualified marriage (Fairbairn, 2016).

Unmarried couples in England and Wales still lack protection from the court when break ups occur. Despite the fact that a court of law takes into account the circumstances and history of their relationship in ensuring fair division of assets, everyone still has the right to maintain all their acquired property. Courts still find difficulties in determining on proper division of properties in the cases where there are no clear circumstances. All in all, solutions on division of property are reached basing on some provisions in the law.

The general rule on property ownership holds that property registered by one spouse is not subject to sharing or division in case the two separate. However, this rule does not apply in all circumstances pertaining to their marriage. For instance, if by any case, there were agreements between the two spouses on division of property. The same rule does not apply to property acquired by both spouses but registered one spouse’s name (Unmarried Couples Rights, 2016).

The family law act holds differently when it comes to property ownership by cohabiting spouses with at least two years in their relationship. Through provisions of the family law act these spouses are given same legal rights as married spouses. Among these rights is the 50/50 division of property in case they break up. Therefore, a house or household property acquired during their relationship might end up being divided in equal amounts between them. However, this rule does not apply to scenarios where property was acquired one spouse before they entered into a relationship (Papworth, 2013).

A spouse has no legal rights to claim shares in property they found their other spouse already in possession even if they may contribute to it in one way or the other. Take for instance, a lady move into a house owned by a man, even if she may contribute to paying mortgages or paid in other form. Such ways may include staying back at home to look after children or paying for household expenses. This is owing to the fact that there is no law or provision regarding rights for personal maintenance even she might have offered financial support for over  five years during their relationship. However, they could enter into an agreement or the other spouse in ownership of the property voluntary agrees to share with the other (Unmarried Couples Rights, 2016).

Cohabiting spouses in joint ownership of family home have a fifty percent legal right claim according to English law. Despite the fact that one of the couples might have contributed more than the other, both couples are entitled to 50:50 share of the property. However, there are provisions for spouses who had entered into a legal agreement on how they were going to share their property. In this case, spouse with the highest contribution might be entitled to more than half ownership of the property. A spouse may also challenge against the 50:50 share rule, something that might not be that easy or very much expensive (Papworth, 2013).

Division of Family Home in the Republic of Ireland following Civil Partnership Certain Rights and Obligations Act 2010

The law in Ireland is clear on the differences between a family home and that of a shared home. According to the civil partnership and certain rights and obligations act 2010 a shared home is any dwelling or place of stay that civil partners stay. A family home on the other hand refers to a place of residence to a married couple. Ordinarily most family homes are registered in the name of both spouses. This has been achieved owing to the fact that it is among the conditions of mortgage used to when buying homes. For the few homes owned by one spouse, there are no restrictions or payment of stamp duty or registration fees during the process. The same applies to shared homes that are in the sole name of one spouse (Family and shared homes, 2016).

The Family Home Protection Act of 1976 offers protection for family homes owned by married couples through amendments made by the Family Law Act of 1995. Shared homes are also offered protection just like the case in family homes. This protection denies a spouse the ability to sell, mortgage or lease their family home without the consent of the other. It is there possible for a spouse or a civil partner to apply for court orders to restrict the other partner from using their family or shared home for self-gains (Fairbairn, 2016).

On separation of spouses, whether they were married or civil partners, there is need for agreements on who will be left to occupy the home. In case the two fail to agree the court could intervene to help with a property adjustment order. in this order the court will spell out the right person to live in their home and the given time they may live there. The court will also outline the person with ownership rights and how much each partner owns with regard to their house. In most cases the spouse living with children would be given the home to leave in as opposed to the other (Family and shared homes, 2016).



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