Lecture 27+28 Flashcards
somatic recombination
V(D)J joining
v = variable D = diverse (heavy chain) J = joining
Non-homologous DNA recombination
this happens during the antigen-independent phase
RAG 1 and RAG2 help out
junctional diversity
unlimited
• Addition or removal of nucleotides among V(D)J
joints
• The largest contribution to diversity of antigen
receptors
heavy chain rearrangement
pro B cell = DJ
pre B cell = VDJ
light chain rearrangement happens in immature cells
how does nucleotides get added
tDt
AID
activation induced deaminase
a somatic hypermutation that leads to BCR variability
improves affinity
converts cytosine to uracil
class switching
Requires: T-cell activation through CD40-CD40L interactions
regulated by IL4 (IgE,IgG) and IFN gamma
AID also has a role in class switching
TCR rearrangement
analogous to BCR
the beta chain rearrangement occurs in pre t cell
follow by alpha chain in the immature T cell
does not have hypermutation or class switching
IL1, IL6, and TNF
acute inflammation
TNF has a role in neutrophil activation
IFN alpha and IFN beta
antiviral
IFN gamma
activation of macrophages, increase of MHC
expression….Chronic inflammation
IL8
neutrophil attractant
chemokine
IL5
eosinophil activation
IL4
class switch to IgE
IL7
development of lymphocytes from pro to pre cells
IL3
development of myelocytes
IL10 and TGF beta
downregulation of immune response
IL12
Produce by macrophages to activate Th1 cells.
Important in granuloma formation
Reason’s swiss cheese model
have active factors (accident happening) or latent factors (accidents waiting to happen)
different safeguards may prevent accidents
barriers which as the CPOE
root cause analysis
used to identify the causative factors that underlie variations in performance
typically will evaluate a sentinel event
identifies the cause and improves systems and processes to decrease the odds of the event happening again
retrospective approach
what, how, and why did this happen
Fishbone (Ishikawa) Cause-and-Effect Diagram
identify system cause of error and develop action plans that include strategies that reduce the risk of future similar events
Failure Mode and Effects Analysis (FMEA)
A systematic and proactive process of anticipating failures, determining the impact of those failures and determining the likelihood of that failure being
detected before it occurs
the goal is to prevent patient problems before they occur
errors will always occur
Plan-Do-Study-Act (PDSA) Cycle
Four-step cycle that allows one to quickly implement “relatively small-scale” change,
solve problems, and iteratively or continuously improve processes
