Economic Indicators Essays - National Accounts, Economic Indicators

Economic Indicators The million (or should we say 'billion' now) dollar question is whether or not the United States' economy will stay in it's record 107 month expansion (according to the index of leading indicators) or come out of the boom and take a downturn into a recession. Nobody, including the Chairman of the Federal Reserve, Alan Greenspan has a crystal ball to provide insight as to what will happen if interest rates are raised, lowered, or left alone. However, Economists have developed a set of indicators to aid in predicting when a recession is about to occur and when the economy is in one. Indicators should not be mistaken for predictors. They are simply forecasting tools, and like any forecast can be misleading. The index of leading indicators that is reported in the popular press shows our economy is still in an expansion. For the purposes of our evaluation of the economy, we chose the Principle Economic Indicators tracked by the Bureau of Economic Analysis and the U.S. Census Bureau under the Economics and Statistics Administration at the U.S. Department of Commerce. There are thirteen Principle Economic Indicators, and they fall into five major categories: National Output and Income; Orders, Sectoral Production, and Inventories; Consumer Spending; Housing and Construction; and Foreign Trade. National Output and Income The first of the five major categories directly relates to measuring the growth of the U.S. economy. National Output and Income consists of the Gross Domestic Product (GDP), Personal Income, and Corporate Profits measurements. GDP is the primary measurement of growth and measures the total amount of goods and services produced by governments, businesses, people, and property located within the United States. Both real (adjusted for inflation) and nominal (current value in dollars) data is collected for computing the GDP. The base year for the real data is 1997. The GDP is normally reported as an annualized quarter-to-quarter change. The reason this measurement is vital to tracking the growth of the U.S. economy is self-explanatory. When the economy is growing, both total income and total output are increasing. Furthermore, a steady increase in the GDP is healthy for the economy. According to the U.S. Department of Commerce, U.S. economic output has grown at an annual rate of 2.5 to 3.5 percent since 1890. The preliminary estimate of GDP in the fourth quarter of 1999 rose at a 6.9 percent annual rate, which is the strongest gain since a similar increase in mid-1996. This is an increase from the initial estimate of 5.8 percent and is consistent with the expectations of analysts. It is also a reflection of the widespread upward increases among the major spending components, including consumer spending, goods exported, and state and local government spending. In the third quarter of 1999, GDP rose 5.7% as a result of increases in Personal Consumption Expenditures, nonresidential fixed investment, and exports. Personal Income is a measurement of total pretax income earned by individuals, non-profit organizations, and private trust funds. It is expressed at an annual rate also. The more Personal Income increases the greater the potential for the American people to spend and save money, which directly influences the growth of the U.S. economy. Personal Income rose .7 percent in January, following an increase of .3 percent in December. The average monthly increases in 1999 were .5 percent. Some extenuating factors affected income in recent months, including cost of living increases in federal transfer payments, a federal pay raise, and agricultural subsidy payments in January. Real disposable income, income after taxes and adjusted for price changes, increased by .7 percent. There was no change in December. The individual personal saving rate rose from 1 percent in December, which was its low, to 1.4 percent in January. Savings rates generally go down in the months October through May due to Holiday spending (includes "paying off" credit cards). There are two methods in which Corporate Profits are reported by the government. "Tax-based" profits are derived from corporate tax returns, and "adjusted" profits reflect earnings from current production. Just as increases in Personal Income are vital to the growth of the U.S economy, increases in Corporate Profits are just as important on an even larger scale. The greater the profits, the more potential for growth. This in turn has a direct effect on employment rates, spending, etc. Profits reported from current production increased $3.7 billion in the third quarter of 1999. This is a dramatic improvement from a decrease of $6.5 billion in the second quarter. Profits would have been about $10 billion more than they were in the third quarter if

buy custom Albuterol in Asthma essay

buy custom Albuterol in Asthma essay Asthma is one of the most common pulmonary illnesses that affect more than fourteen million people in the United States (CDC, 2008). The prevalence of asthma is increasing in most countries, and estimates show that the numbers are likely to rise by 100 million by 2025 (Bateman et al., 2008). Asthma is characterized by reversible airway obstruction following exposure to environmental allergens or irritants or respiratory viral infection (CDC, 2008). Asthma is also characterized by impediment and irritation that occurs in many patients. Treatment of asthma has always been medications that are aimed at controlling the inflammation as well as the medications for general relief of the severe symptoms. However, the recommended management is the clinical assessment of the symptoms and the lung function assessment of an individual. These are viewed as the measures of the outcomes that result from this condition. Most asthma exacerbations are dealt with in various outpatient systems. However, more severe conditions require hospitalization. These hospitalizations are responsible for the foremost healthcare expenditures by patients. In the United States, these hospitalizations lead to over 400,000 cases of asthma hospitalizations annually. This eventually leads to very high expenditures for asthma related conditions (Bharmal Kamble, 2009). Asthma in both children and adults is associated with an increase in direct expenses, which eventually brings the expenditure to a very high level according to healthcare costs. The main therapy in the treatment of asthma is the administration of 2-receptor agonists which reverse the acute airway obstruction as well as other conditions such as cough. According to Ameredes (2009), levalbuterol and albuterol are the most common short acting 2-receptor agonists in the treatment of asthma. Racemic albuterol is a mixture of two stereo isomers R-albuterol and S-albuterol. Clinical studies have distinguished the two isomers in terms of their affinity. Studies upon isolation of the two isomers have revealed that R-albuterol is responsible for the bronchodilator activity. However, S-albuterol does not possess bronchodilator characteristics, but it acts in association with various pharmacological activities to neutralize the therapeutic effects of R-albuterol (Handley, 2000). Levalbuterol, also referred to as levosalbuterol is an alternative treatment for asthma and other pulmonary illnesses such as Chronic Obstructive Pulmonary Disorder (COPD). It blocks the beta-2-receptor to prevent the constriction of the airways in these conditions, and is therefore called a bronchodilator. Cells in the airways contain receptors that are called beta-2 receptors. Levalbuterol binds and activates the beta-2 receptors and is hence referred to as a beta agonist. This initiates signaling within the cells which results to the relaxation and opening of airways. However, the safety of albuterol and Levalbuterol is generally different. The S-isomer in albuterol has been believed to be inert in nature and its presence in the drug of no consequence. But it is now thought to foreshorten the duration of R-albuterol by compressing its potency (Handley, 2000). The main purpose of this study is to provide a comparative view of asthma related therapies, as well as the outcomes of tre atment after the maintenance treatment of asthma using levalbuterol and albuterol. Literature Review Studies in patient preferences on the type of medication provide crucial information on the evaluation of asthma symptoms as well as the effects of medication on the wellbeing of the patients and the levels of functional activities (Bateman et al., 2008). These studies have been insufficient in evaluating the effectiveness of albuterol in treating asthma. Albuterol has been in use for a long time but is said to be associated with various side effects such as tachycardia and jitters. The introduction of levalbuterol in 1999 has brought an opportunity to assess patient predilections between albuterol and levalbuterol. A stepwise approach to disease management is necessary for the assessment and eventual treatment of asthma. One of the main goals of asthma treatment is to uphold the wellbeing of people as one of the main humanistic upshot measures (Reed, 1985). Today, clinicians use many other measures to manage diseases with a need to control the effects of asthma as well as the wellbeing of the patients. These measures include patient satisfaction as well as other health related measures that are centered on the quality of life. Studies have revealed that patients preferences have a great impact on medication side effects, as well as patients quality of life. Patients compliance with the medication is also necessary for successful control of asthma (Bharmal Kamble, 2009). Disease control measures are also very crucial in reinforcing the positive perceptions of the treatment of asthma. When levalbuterol was approved in 2005, studies suggested that its use resulted in better respiratory parameters as well as fewer hospitalizations that brought about very little, if any, side effects and though it is priced much higher than albuterol since it has a higher duration of action (5-8 hours) as compared to albuterol (4-6 hours), its use led to generally lower treatment costs in terms of hospitalization and subsequent treatments (Carl, 2003). Studies comparing levalbuterol to albuterol revealed that levalbuterol yielded bronchodilation with few side effects. However, these results are not universal and some studies suggest no significant differences in clinical endpoints. The baseline distinctiveness for the two groups of patients (those who were administered with albuterol and those who were administered with Levalbuterol) was very distinctive (Ameredes, 2009). In the medical field, albuterol has been in use for a long time, one of the factors that make it preferable. Due to the mixture of the two isomers (R)-albuterol and (S)-albuterol that are considered inert, albuterol is considered somewhat classical in the medical field. However, the single-isomer formulation that has been manufactured recently is used therapeutically when the other component is deemed to be undesirable. Pharmacology Levalbuterol and albuterol are 2-receptor agonists and they reverse the acute airway obstruction as well as other conditions such as cough. The two drugs serve to reduce the resistance in the airway as they are known to enlarge the diameter of the bronchi or the air passages (Ozminkowsk et al., 2007). These drugs, therefore, help to enhance the overall flow of air both into the lungs and out. The drugs work on the beta-2 receptors resulting in the relaxation of the pulmonary smooth muscles (Perrin-Fayolle et al., 1996). Studies conducted with regard to the metabolism of levalbuterol in the human tissues indicate a 5-11 fold better sulfoconjugation within various human tissues than albuterol. A single dose of the albuterol dosage, whether taken orally or inhaled, results in a higher blood level within the body than levalbuterol (Perrin-Fayolle et al., 1996). Perhaps, this indicates a predominance of the (s)-albuterol, an inactive product, after repeated dosing of the active albuterol. It is estimated that up to 8 % of patients who receive nebulized racemic albuterol develop paradoxical bronchospasm, a condition which is life threatening. This decline in efficacy could be attributed to the composition of racemic albuterol. Levalbuterol is the therapeutically active bronchodilator in racemic albuterol, also referred to as (R)-albuterol. Evidence indicate that (S)-albuterol does not possess any bronchodilatory activity, in fact, it increases the level of calcium in the smooth muscle cells in vitro, which favors contraction and opposes bronchodilation. This also leads to increased in vitro bronchial reactivity of human airway smooth muscles. Clinically, the isomer promoted increased hypersensitivity and increased bronchospasm that is methacholine induced in patients with moderately severe asthma. On the contrary, levalbuterol, when administered as a single isomer, eliminates all the detrimental effects of (S)-albuterol (Bateman et al., 2008) Research has also shown that racemic albuterol and Levalbuterol are important since they produce effects that can be used as prescriptions for cancer treatment. The treatments include corticosteroid strengthening and the diminution of inflammatory mediators. However, on the other hand, (S)-albuterol produces contradictory effects. Studies indicate that the adverse effects associated with albuterol, such as jitters, tychardia and bronchospasms, are less frequent with levalbuterol (Gawchik, 2007). Symptom relief was also perceived to be higher, leading to a greater overall satisfaction with Levalbuterol treatment. However, it is important to bear in mind that while levalbuterol and albuterol help in relaxing the smooth muscles and increasing the flow of air within the airways, they do not actually reduce the speed of the progression of the primary disease (Ozminkowsk et al., 2007). They only help in minimizing the signs and symptoms of exercise and wheeze limitations along with the sho rtness of breath, leading to a better life for the people living with COPD. Improved outcomes Many investigators in their publications from studies have revealed that the use of levalbuterol yields better symptom relief and less frequency of the adverse effects as compared to albuterol. However, their pattern of outcomes cannot be applied universally because other studies propose that there is not a clear difference in clinical endpoints. Ozminkowski Wang (2007), state that the various publications that have resulted from various studies are difficult for doctors to follow. Most of these data highlight the effects of albuterol and levalbuterol in efficiency and safety. This was done by comparing the relief of symptoms and the exhibited side effects of each form of treatment. However, this clinical research provides no superiority of levalbuterol over albuterol. The effects of levalbuterol may be greatest to patients with moderate to severe asthma, especially in cases of racemic albuteol overuse (Ameredes, 2009). When a patient inhales racemic albuterol, he or she has a persistent effect that is caused by (S)-albuterol. This is in comparison to levalbuterol. This suggests potential contradictory outcomes from clinical experiments. One study carried out on children under the age of twelve years evaluated the treatment of asthma in children by caregivers who used either albuterol or levalbuterol. Various interviews were scheduled for caregivers, and the main questions were the satisfaction level of their children with bronchospasms. The caregivers were supposed to report contentment or discontent. The patients were administered with albuterol and levalbuterol for four consecutive weeks. After the first dose, levalbuterol created a greater relief of symptoms compared to doses of albuterol in nearly all patients including those with relentless asthma (Carl, 2003). Ameredes (2009), carried out a research study to find out the distinctive difference between albuterol and Levalbuterol. The objective of this study was to find out whether levalbuterol reduced the costs of treating asthma as compared to albuterol and to find out the various ways that levalbuterol and albuterol were different. He used a correlational research design that brought forward thirty seven patients who were diagnosed with acute asthma. The patients in his sample were children between the ages of 6-18. The results of this study indicate that Levalbuterols potency is 2-fold than racemic albuterol and 90 to 100 fold more than S- albuterol. Ameredes (2009) suggests that there have been highly heterogenous results from various studies that compare the clear differences between albuterol and levalbuterol. In one study, levalbuterol was more effective in suppressing bronchospasm than (R) albuterol and (S) albuterol. However, subsequent research studies revealed that there are equivalences between albuterol and levalbuterol. Some indicated that the effect of 1.25 mg levalbuterol was similar to that of 2.5 mg racemic albuterol, with (S) albuterol showing little measurable effect. The above studies were shot-term, and thus a short-time approach would be used to evaluate the two drugs. This approach, however, did not measure the difference that existed between albuterol and its isomers, if used chronically. Nelson (1998), conducted a clinical trial that would compare albuterol to levalbuterol. The study was based on both children and adults that were diagnosed with acute asthma in the United States. In his study, the patients were selected randomly and assigned levalbuterol or racemic albuterol. This trial was aimed at checking the equivalences of equal amounts of the two drugs. The study was correlational and involved fifteen patients from a local hospital. The study resulted in greater improvements in force expiratory volume in one second in the levalbuterol group as compared to the dose-equivalent of racemic albuterol group. This implied that an equimolar dose of levalbuterol produced better results than albuterol. The dose that produced numerically equivalent bronchodilation as recemic albuterol, 2.5 mg, was 0.63 mg levalbuterol, not 1.25 mg which is the mass equivalent dose. The interpretation of this data shows a particularly damaging effect of S-albuterol (Nelson, 1998). Clinical studies have been carried out in pediatric patients with asthma. According to Gawchik (2007), a randomized placebo-controlled trial was necessary to compare the two drugs. In his study, he discovered that no differences existed in bronchodilation with levalbuterol and albuterol. This was because there was no dose-related correlation in children with moderate asthma. However, the dose-related correlation was found in children with severe asthma. In another study of acutely asthmatic patients between the ages of 6-18 years, there was a conclusion that the more expensive levalbuterol did not reduce the amount of return visits to the hospital for further asthma management as compared to racemic albuterol (PerrinFayolle, 1996). The treatment also did not shorten the length of stay at the emergency department, improve expiratory flow (PEF), neither did it reduce the number of nebulized treatments when compared to racemic albuterol. On the other hand, contrary to this, Gawchik (2007), writes about the new form of albuterol inhalers that are in use in the market since 2009 in a bid to compare albuterol to levalbuterol. He notes that due to the recent changes, the new form is adjusted and better in terms of the security of use due to the fact that they are both human and environmentally friendly. The chloroflouroalkane found in rescue inhalers both in levalbuterol and albuterol have been found to harm the environment. Therefore, the inclusion of hydroflouroalkane has been important as a propellant. This is actually a positive step in the study of the effects of the two types of drugs. Ozminkowski Wang (2007), conducted another age-stratified randomized study with hospital admission rate of the patients presented to the emergency department as the outcome. The study was aimed at finding out the frequency of admission of patients to the emergency section and the return rate after discharge. The objectives of this study were to find out the patient-return rate after treatment in the emergency section and find out the role played by levalbuterol in assisting the quick recovery of patients in the emergency section. The admission rate was lower in the levalbuterol group as compared to the albuterol group (Ozminkowski Wang, 2007). The risk of the admitted group was greater in the albutrerol groups than the levalbuterol group. However, the length of hospital stay in the levalbuterol group was not significantly shorter than the albuterol group and there were no adverse effects in both groups. In this study, the conclusion was that substituting the administration of albuterol with levalbuterol would reduce the number of hospitalizations (Carl et al., 2003). This was supported by another study by Nowark et. al. that showed that levalbutereol was preferrable to albuterol in the treatment of acute asthma. Administration of the same dose showed that improvement was greater in levalbuterol as compared to racemic albuterol. The study also indicated that patients with higher plasma levels of (S) albuterol show slower improvement and have a higher likelihood of hospital admission In the same research, the investigator notes several factors. First and foremost, he acknowlegdes the fact that abuterol is the most commonly prescribed inhaler with beta-2 agonist. In addition, he notes that it is also considered the best drug when it comes to reversal of acute bronchospasm. Due to the equal mixture of (S) and (R)-albuterols, there is little effect of broncholdilating activities. On the contrary, the (R)- albuterol has a better binding effect to beta-2 receptors as compared to the (S)-albuterol (Tripp, 2008). According to the investigator, the creation of levalbuterol was needed for several reasons including fewer incidences of transcient tachycardia; the chance of better tolerability as compared to albuterol; and a higher efficacy than albuterol. A further examination of the research, showed that patients benefit more from levalbuterol. Additionally, the outcomes of the study revealed that levalbuterol was better than albuterol in a sense that patients treated with levalbuterol required less medication after recovery and that they had shorter lengths of hospital stay. A regression analysis revealed that levalbuterol was allied with duration of stay savings. Another study conducted by Truitt, Witko, Halpern (2003), showed similar improvements in FEV and mean heart rate decreased with levalbuterol. This study that was carried out in comparison to albuterol. However, the researchers note that the magnitude of the difference is minute. Therefore, it is important to study these differences together in order to detrmine the most reliable results. Nonetheless, the investigators note that results may be helpful to patients who are affected with arrhythmias, cardiac conditions and structural heart diseases. This is because if the differences are not considered, it may worsen the heart condition. Therefore, the investigators note that the transcient tachycardia that is evident in cardiac patients may be a key indicator of the dose dependancy that is formed with time by patients who use levalbuterol and albuterol (Truit, Witko Halpern, 2003). In another study, Nowak (2008) and his colleagues compared the effects that are brought forth by nebulized levalbuterol. This was in comparison to the ones that are brought forth by racemic albuterol. The subjects were 627 adults who suffered from acute asthma. The subjects were radnomly given the opportunity to use either 1.25 mg of levalbuterol or 2.5 mg of albuterol. This was after twenty minutes of emergency admission and 40 minutes later all the patients received 40 mg of prednisone. The level of expiratory volume was forcefully increased by 40 percent when the patients were administered with levalbuterol, this is in comparison to racemic albuterol. The investigators also discovered that this coresponded to a fourty percent reduction in the subjects who required hospitalization (Nowak, 2008). The effects of levalbuterol were evident in patients who had severe asthma. The high levels of (S)-albuterol in the circulating plasma are thought to be the main cause of overuse of racemic albuterol. The number of relapses in the two groups after a period of thirty days, however, did not differ. In another randomized clinical trial, Carl et al. compared the use levalbuterol with racemic albuterol in over 500 pediatric patients reporting to a hospitals ED. Hospital admission rates were reduced among those receiving levalbuterol in comparison with those receiving racemic albuterol treatments. The study was also seeking to establish the hospital conversion where levalbuterol racemic albuterol was replaced with levalbuterol 1.25 mg every 8 hours or levalbuterol 0.63 mg every 6 hours. Despite that the frequency of levalbuterol was less, the patients required fewer rescue treatments to reduce the symptoms than did those treated with racemmic albuterol. This means that the less frequently scheduled treatments with levalbuterol will lead to reduced workload and reduced number of missed treatments because of unavailability of therapists. This is also supported by Truit et al, who reported that treatment with levalbuterol required one day less of admission, significantly fewer treatments and a 67 % decrease in readmissions within 30 days of discharge after treatment with the 2-agonist compared with racemic albuterol. Other studies reported similar results, indicating that treatment with levalbuterol reported decreased numbers of daily treatments, reductions of staffing and fewer as-needed treatments when compared to racemic albuterol as the acting 2-agonist. Nowak (2008) conducted another study of patients who suffered from acute asthma and another group suffering from chronic obstructive pulmonary disease (COPD). There was a comparison of treatment of levalbuterol and albuterol that were administred in a period of 6 to 8 hours in 1.25 and 2.5 miligrams repectively. There were fewer nebulizations that were requiredwhen it came to the case of levalbuterol. On the other hand, there was an increased need for rescue aerosols in the period of 14 days hospitalization. However, most of the other outcomes were similar in the two groups. This is including the costs and study of the pulmonary functions. In the study by Truitt et. al. (2003), the retrospective chart review on hospitalized patients who had asthma and COPD showed that the results were more or less the same. This therefore led to the conclusion that the benefit of levalbuterol over albuterol is usually greatest in patients who have moderate as compared to severe asthma, particularly t hose with an overuse of albuterol. Side Effects Vitro and animal studies have shown significant outcomes that can be used as a basis of comparison. Many research studies reveal that albuterol is associated with severe effects that raise concerns, such as chest pain and high blood pressure. This could be because of the fact that inhalation of racemic albuterol leads to pushiness in circulating S-albuterol twelve times more than levalbuterol (Ameredes, 2009). Levalbuterol has been acclaimed to be a safer form of albuterol but it comes at increased costs. It costs five times more than racemic albuterol. According to Gawchick (2007), albuterol is purely used for the treatment of symptoms that are occasional but an overdose of the drug can be fatal. One of the precautionary measures that should be taken when using albuterol is that the use should be discontinued in cases of adverse side effects, including hypersensitivity; abnormal heart rhythms; diabetes; epilepsy this is coupled with seizure disorder; and heart diseases. The researcher also notes wheezing, pounding heart, tight chest, nervousness, blood pressure, and chest pains side effect may be a sign of hypersensitvity. Evidence from preclinical and clinical studies suggest that the worsening of asthma symptoms in some patients with continued use of albuterol or its overuse could be contributed by the racemic mixtures of albuterol isomers, which may result from the presence of the (S)-albuterol. The slow phamarcokinetic profile is one significant characteristic of (S)-albuterol. It is metabolized 12 times slower than levalbuterol. This is because it does not have sulfation and elimination enzymes preferrentially specific to levalbuterol. This leads to the differences in circulating levels of the isomers after administration of racemic albuterol. After administering a dose of inhalable racemic albuterol, it has been shown that the circulating levels of levalbuterol are undetectable wheras the levels of (S)-albuterol persisit for as long as 12 hours and may be preferentially retained in the lungs (PerrinFayolle, 1996). Therefore, it is important to consider the physiologic and pharmacologic effects of each isomer within the racemate mixture separately. According to Truit, Witko Halpern (2003), the issue of tolerance is still a bit controversial. There are some researchers that have noted that the overuse of racemic albuterol may lead to some factors that include hypokalemia and even increased mortality. Therefore, due to the lack of bronchodilator activities in (S)-albuterol, there may arise the situation of worsening air activity or rather pro-inflammatory effects. This is because it is metabolized 10-fold slower than levalbuterol (Truit, Witko Halpern, 2003). This could additionally result in the accumulation of (S)-isomer over (R)-albuterol leading to paradoxic bronchospasm. In addition, patients who suffer from asthma or COPD and other cardiac diseases have a likelihood of worsening the situation when they experience tachycardia and this therefore means that they are safer when using levalbuterol as compared to albuterol (Lovtall, Palmqvist, Maloney, Vantresca and Ward 2004). Studies have also discovered poor adherence to med ication by patients who suffer from tachycardia The other main factor that was noted when comparing the two agents is cost. Before the year 2009, the metered-dose inhaler (MDI) that had generic formulations was widely available. There were also versions of albuterol that were much cheaper. They included proventil and ventolin. This fact also applied to levalbuterol. On the contrary, many of the MDI formulations contained a lot of chloroflourocarbon and therefore, this meant that they had to be banned by the FDA (Food and Drug Administration). This was particularly due to environmental reasons. Therefore, the unavailabilty of the MDI has led to the leveling in price of the two agents (Truitt et. al., 2003). However, there are variations in the cost of levalbuterol nebulization as compared to albuterol nebulization. The use of levalbuterol faces various limitations including higher costs, small sample size in terms of testing, inadequate manpower and lack of support by many researchers This however, does not mean that albuterol should be preffered over levalbuterol since there are instances when levalbuteral tends to be widely accepted. First and foremost, there is a need by patients who have severe chronic asthma to get the doses of beta-2 agonist. This happens in spite of the use of controller therapies. A study by Tripp (2008) showed that levalbuterol resulted in Forced Expiratory Values (FEV) that were equivalent to or better than those that were observable in albuterol. The -mediated effects were lower for a single dose of levalbuterol as compared to racemic albuterol. In this studies, treatment of asthma using levalbuterol was cheaper due to the little numbers of hospital admissions (Tripp, 2008). In this particular study, levalbuterol treatment in the emergency department was cost effective because it led to a situation of patients recovering faster and thus reducing the cost of healthcare. Although the (R) -albuterol and (S) albuterol isomers are similar in their molecular weight and their physiochemical properties, their 3-dimensional structure makes them super imposable. This conformational stereochemistry makes their properties distinct and for each isomer which results to them being considered different compounds (Nelson, 1998) As a result, regulatory authorities have demanded that the potential risks associated with the mixtures that make up racemic albuterol be quantified. Levalbuterol was developed to minimize the side effects associated with (S)-albuterol and maximize therapeutic effects. The findings of this study demonstrate that the use of levalbuterol significantly reduces hospital admission rates in patients presenting to the ED with acute asthma when compared to racemic albuterol. The study suggests that levalbuterol has clinical benefits over racemic albuterol in critical care settings, and these benefits are evident in both pediatric and adult patients administered with levalbuterol. The above studies were conducted in geographically distinct ED settings, with varying patient populations, physicians, and socioeconomic conditions demonstrating that substituting racemic albuterol with levalbuterol improves patient outcomes by reducing hospital admissions. Different studies have suggested that levalbuterol produces greater bronchodilation than racemic albuterol and improves discharge rates and health resource use (Ozminkowski Wang 2007). A post-hoc analysis on the patients found that their (S)-albuterol plasma levels negatively impacted their baseline forced expiratory volume in 1 second as well as pulmonary function an hour after ED treatment was commenced. Despite the higher cost of levalbuterol in the treatment of asthma, when the total costs are considered, the differences in the costs are insignificant. The overall costs were similar in the levalbuterol group and the racemic albuterol group. The cost reductions were reported with increasing severity of asthma. This results from reduced hospital admissions and less frequent dosing, making the treatment more cost effective despite its high cost (Nowak, 2006) The clinical and preclinical benefits of levalbuterol observed in the literature cited in this investigation occur due to the difference between the two agents which is the presence of (S)-isomer in the racemic mixture. Despite previous studies suggesting that it is inert, the (S) isomer may instead have some proinflammatory effects. The bronchoprotective efficacy of racemic albuterol progressively declines with regular use, leading to reduced interval between dose and decreased bronchodilation (Nelson, 1998). The above findings indicate that levalbuterol, when used in place of albuterol reduces the number of hospital admissions, and is cost effective in the treatment of acute asthma in the ED setting. This makes the observations provocative and interesting since the only difference between the two agents is the presence of the (S)-isomer in the racemic mixture. The mainstay of therapy for reactive airway diseases has been rapid-onset 2-agonist agents such as racemic albuterol. However, the recent isolation of (R)-isomer levalbuterol has provided a new option for the treatment of asthma and COPD. The use of levalbuterol therapy produces both clinical and economical advantages when compared to albuterol therapy. Buy custom Albuterol in Asthma essay

Capacitors in series and parallel ((lab- report )) Coursework

Capacitors in series and parallel ((lab- report )) - Coursework Example During the experiment, the series connection started followed by the parallel connections. At every stage, data collected assisted in computations. The experiment involved the use of voltmeter to measure the voltage drops, a capacitance meter to measure the capacitance and calculations to tabulate data obtained. Series circuit produces the equivalent energy of 0.00031 joules while parallel produces the equivalent energy of 0.00372 joules. Parallel circuits provide more stored energy, thus is the best method to connect capacitors. The experiment derives a capacitance of 5.41 microfarad from the series connection and 68.7microfarad from the parallel connection. This is done by a voltage supply of 10 volts when measured the voltage is 10.42 volts on the series connection and 10.31 volts after parallel connection. This helps determine the amount of average charge in both series and parallel circuits as the series circuit has an average charge of 56.37Â µC, and the parallel has an average charge of 708.297 Â µC. The series circuit has the lowest voltage drop of 1.56volts while the parallel circuit has the lowest charge at 97.95 Â µC. The capacitors in series circuits produce an equivalent capacitance of the sum of the reciprocals of the capacitance of each capacitor. This in turn reduces the amount of energy stored in the capacitors. Parallel circuits produce and equivalent capacitance equal to the sum of the individual capacitance of each capacitor in the circuit. This makes the amount of energy stored in the circuit be more. The series obeys Kirchoff’s Voltage Law that implies the total voltage equivalent to the sum of all the voltage drops within a circuit Swain (2008). From the experiment, I learned that capacitors play a significant role in storing energy in an electric field thus ensuring a steady flow of energy. To store more energy in capacitors, one needs to use the parallel circuit. In application,

Industrialization after the Civil War Assignment

Industrialization after the Civil War - Assignment Example As the report stresses the exhaustion of the war, ironically, created an atmosphere of peace. This gave vent to the entrepreneurial aspirations of the citizens. But the opportunities were not uniform or equitable. The privileged White Anglo-Saxon Protestant (WASP) community, which owned most of the properties, continued its economic and social dominance. It was this preordained economic privilege for the community that would give rise to such great industrialists as Henry Ford, John Rockefeller, etc. These luminaries were the first great capitalists of the country. Indeed they would develop great companies like Standard Oil and Ford Motor Company, which would supersede in scale and revenues even some older establishments in Europe.From this paper it is clear that the rapid pace of industrial growth had a major socio-cultural impact. It affected the life of the average working American in many different ways. The most important change they witnesses is the transformation of the mode o f livelihood from independent small-farmers to wage-earning factory workers. In fact, the late 19th century labor press was saturated with discussions on such fundamental changes. This transformation was not a smooth and swift process at all. Most small farmers put their independence ahead of job security. They moreover perceived receiving wages from a capitalist master as a slur on their dignity.  

The Relationship Of Organization Structure Commerce Essay

The Relationship Of Organization Structure Commerce Essay The purpose of this report understands you about the organization behavior. To that it includes organization structure, cultures, leadership styles, management approaches, and motivational theories to understand you about the organization behavior. For you to understand this terms this report uses Google and Creative Solutions. Google is a international IT based company which provide various kind of information to the world. Larry page and Sergey Brin are the founders of Google Company. Creative Solutions is also IT based company in Sri Lanka. By using this two companies you can understand how they using different organization structure, cultures, leadership styles, management approaches, and motivational theories to understand you about the organization behavior. Task 01 The Relationship of Organization Structure and Organization Culture (http://en.wikipedia.org/wiki/Google, 2012) Section 01 LO1.1 Compare and Contrast Organization Structure and Culture. In ICT Industry, theres lots of companies in the world and in Sri Lanka that doing their operations. They provided many services to the people. Google is one of famous and leading ICT Company in the world. Google is founded by two PhD students in Stanford University, the massive search engine Google officially launched in September of 1998. These two university students develop this Google very fast. The term of Google become officially in 2006, the term pop-up regularly in our normal conversation Just Google it . Newsdays everyone knows about the Google and its the most popular searching engine in the network. Creative Solutions is has assisted international companies with software development, maintenance, support and quality assurance since 1999. By providing a high quality, cost-effective service out of their state of the art Research and development centre in Sri Lanka, they help their clients meet their deadlines and achieve higher level of profitability. An organization structure a consists of activities such as task allocation, coordination and supervision, which are directed towards the achieved of organizational aims. It can also be considered as the viewing glass or perspective through which individuals see their organization and its environment. And the Organization culture is the collective behavior of humans who are part of an organization and the meanings that the people attach to their actions. Larry Page and Sergey Brin founded Google in September 1998. Since then, the company has grown to more than 30.000 employees worldwide with a management team that represents some of the most experienced technology professionals in the industry. Executive Officers Larry Page CEO Eric E.Schmidt Executive Chairmen Sergey Brin Co-Founder Nikesh Arora Senior Vice President And Chief Business Officer David C. Drummond Senior Vice President, Corporate Development and Chief Legal Officer Patrick Pichette Senior Vice President And Senior Financial Officer Senior Leadership Alan Eustace Amit Singhal Andy Rubin Dennis Woodside Jeff Huber Kent Walker Laszlo Bock Rachel Whetstone Salar Kamangar Shone Brown Sridhar Ramaswami Sundar Pichai Susan Wojcicki Urs Hoelzle Vis Gundotra Board of Directors. Larry Page CEO Sergey Brin Co-Founder Eric E.Schidmit L. John Doerr Diane B Greene John L Hennessy Ann Mather Paul S Ottelline K Ram Shriram Shirly L Tilghman And this is the normal structure of the Creative Solutions, In this two organization their organization structure is different to each other. Google is the fourth-most admired company in the United States. Google was also listed as the top company to work for in both 2007 and 2008. Google is a one of most popular organization that many employees like to have jobs there. The main reason for this employee admiration is Googles cross functional organizational structure, which the company maintains though seller leadership and innovative management techniques. And in the Creative Solutions using a functional organization structure. A functional organization structure is best suited as a producer of standardized goods and services at large volume and low cost.   The culture in an organization plays a major role in the organization. The culture in an organization helps to attract the best talent available in the industry. Google was the one of few companies that successfully blended technology innovation with strong organization culture. The culture in the Google is very interesting, motivate and attractive. Culture in Creative Solution is same as the Google, but exactly not like that. Because the culture in Creative Solution also is very motivate, interesting and attractive. They using small methods to attract innovative people and good customers. LO1. 2 The Relationship between Organization Culture and Structure (http://www.businessdictionary.com/definition/organizational-culture.html, 2012) (http://www.wisegeek.com/what-is-the-relationship-between-organizational-structure-and-organizational-culture.htm, 2012) The Organization Culture in Organization is a major role. Organizational structure and organizational culture have a dependent relationship with one another. In the business world, management structure determines the behaviors, attitudes, dispositions, and ethics that create the work culture. If a companys organizational structure is strictly hierarchical, with decisions making power centralized at the top, the companys culture will likely reflect a lack of freedom and autonomy at the lower levels. If the companys management structure is decentralized, with shared power and authority at all levels, the culture is likely to be more independent, personalized and accountable. Its really easy to work in that structure. The way company allocates power and authority determines how employees behave. These choices manifest in a companys organizational structure and organizational culture. Most companies use a hierarchical structure that looks like a pyramid. The chief executive or president sits at the very top of pyramid. Other officers directly report to him. In the Google, there organizational structure and organizational culture also connected to one another. There hire people who smart and determined, and they favor ability over experience. Although Googlers share common goals and visions for the company, they hail from all walks of life and speak dozens of language, reflecting the global audience that they serve. And they not at work, Googlers pursue interests ranging from cycling to beekeeping, from Frisbee to foxtrot. They strive to maintain the open culture often associated with startups, in which everyone is a hands-on contributor and feels comfortable sharing ideas and opinions. In their weekly all-hands meetings not to mention over e-mail or in the cafà ©_ Googlers ask questions directly to Larry, Serge and other execs about any number of companys issues. Their officers and cafes are designed to encourage interaction between Googlers within and across teams, and speak conversations about works as well as play. The organizationa l structure is very different because they are made up of many shareholders that have a say in what the company does and turns into. In Creative Solutions, their culture and structure attached to each other. The culture in Creative Solutions is very interesting and very motivate, and they using a functional organizational structure. Its best suited as a producer of standardized goods and services at large volume and low cost. LO2.2 Organizational Theory (http://management.blurtit.com/q7346416.html, 2012) Organizational theory and management theory is used in many aspects of a working business. Many people strive to adhere to the theory to help them become better at their jobs or more successful in life, although this may lead to them having to sacrifice some of their personal principles in order to succeed. One example of following organizational theory in the financial sector would be an employee or manager who wants to know how to achieve goals by having a set structure to follow. In addition, someone in a Human Resources sector will have to make decisions throughout their working day that will undoubtedly change the structure and practice of a working day for all other employees in the company. If an individual gets so wrapped up in trying to fit the mould of what they interpret their role should be in terms of organizational theory, they may start to neglect other areas of business. In the same way, management theory may also underpin the personal values of some individuals. For instance, they may disagree with a particular rule or regulation that has been introduced by the company, however in order to carry out their job as a manager effectively and professionally, they need to move away from their principles and execute the job. It is difficult to try to execute both management and organizational theories as a psychological contract between the employer and employee still needs to be maintained. This will need to consider how fairly the company is treating the employee and how fairly the employee is treating the company, i.e. are they actually putting 100 percent effort into their work? Any changes to the organization or management in a company, is undoubtedly going to have an effect on all of this. LO2.3 Different Approaches to Management used by Google and Creative Solutions. Google Human behavior approach. This is based on psychology and social psychology. It means management should understand about the human behavior. Management should increasing productivity through motivation and good human relations. In Google they creating friendly, peaceful and relaxed environment for their employees. In Google, their employees highly motivated to their duty well. They maintain a simple and open communication structure. Google has a flat structure that uses cross hierarchical, cross functional teams and they good at decision making. Relationship approach. This means keeping a good cultural relationship. Relationships exist among the external as well as internal environment of the organization. Cooperation among group members is necessary for the achievement of organization objectives. For effective management, efforts should be made for establishing harmony between goals of the organization and the various groups therein. In Google they maintaining with the Laissez- Faire style. This will help to keep to good, strong relationship between employees and the leaders in the Google. Selecting employees approach. In Google, they selected their employees in a special way. They get billions of application in a year. So they are maintaining a good employees selecting system. They are selecting people with good skilled, good personality and with high academic achievements because its easy work with them and its saving Googles money. Creative Solutions Culture approach Creative solutions create a good, friendly and attractive environment for their employees that can work easily. Its always encouraging the employee to do their best and highly motivated. Keeping same leadership style In Creative Solutions they using Democratic Leadership styles, and its help them to encourage their employees to make good decisions and sharing ideas. Interpersonal behavior. Creative Solution always focusing on their employees interpersonal behavior. So that they always selecting, training their employees to make them as good, skill full employees. Section 2 LO2.1 Different Leadership Styles There are different leadership styles in an organization they used to have a successful growth. There are three leadership styles in management, Autocratic Leadership Style Democratic Leadership Style Laissez-Faire Leadership Style In Google they are using Laissez-Faire Leadership Style. The French fraise means leave it be. It describes a leader leave his her colleagues to get on with their works. These types of leadership works for teams in which the individuals are very experienced and skilled self-starters. The Company hired smart engineers, promoted most brilliant into leadership positions and then pretty much left them alone. The reason to do that, they were smart and if they have any problem they figure it out or ask questions if they needed help. Google took time and effort to find out the leadership qualities that are most important in their culture. And in the Creative Solutions, they using the same leadership style in their culture. The effectiveness of this Laissez-Faire Leadership style is final responsibility still lies with the leader. The Laissez Faire leader lets her followers have free reign over the approach, the decision making and basically all aspects in getting the job done. In Creative Solutions they are using democratic leadership style in their structure. Democratic Leadership style, leader will take the final decision, and he/she invites other team members to contribute the decisions-making process. By involving this increase the job satisfaction and also develop the peoples skills, and so motivated to work hard. This style takes more time to take things happen, but the end result is better. LO3.1 -Faced the Technological Breakdown Using Different Leadership Styles Last week theres a huge technological breakdown, and its effect to the whole industry. Because of that most companies in the industry has fallen down in their operations. This technological breakdown not only effect to the industry, its effect to the share market also. And also it effect to the industry in worldwide. In this situation Google is different leadership styles to face this technological breakdown. And Creative Solutions also using different leadership styles to face this technological breakdown. Normally Google is using Laissez-Faire Leadership style in their organization and Creative Solution using Democratic Leadership style in their organization. But in this case its better if they use all three leadership styles, because good leaders use all this three leadership styles to get the best result in their activity. By using all three leadership styles in this case, we can avoid this technological breakdown. In autocratic leadership style leaders tell their employees to what they want done and how they want it accomplished, without getting the advice from their followers, its better use it is when you have all the information to solve the problem, you are on short time and your employees well motivated. And this is using for only rare occasions. In democratic leadership style, involves leader including one or more employees in the decision making process, it allows them to become part of the team and allows you to make better process. And the leader maintains the final decision. By using all this three types of leadership styles its easy to identify the problem and faced it well, and also its good for the employees motivation. Section 3 LO3.2- Motivational Theory (http://www.managementstudyguide.com/maslows-hierarchy-needs-theory.htm, 2012) Motivation is a word divided from Latin word movere, meaning to move. Motivation is a general term applying to the entire class of drives, desires, needs, wishes, and similar forces. Motivation can be either positive or negative. Its a process that accounts for an individuals intensity, direction and persistence of effort toward attaining an organizational goal. Diagram 01. There are Three Major Motivational Theories in management. Maslows Hierarchy Theory of Needs Aldefers ERG Theory Herzbergs Motivation-Hygiene Theory Maslows Hierarchy Theory based on the assumption that there is a hierarchy of five needs within each individual. This Maslows Hierarchy Theory most often display like a pyramid. The lower level in the pyramid, are made for the most basic needs and the complex needs are in the top of the pyramid. Each one of these needs significantly satisfied its drives and forced to the next level. Applying this Maslows Hierarchy Theory to the Creative Solutions, we can identify what are the higher-order needs and what are the lower-level needs and then can find a way to satisfy them. In Aldefers ERG theory, he recatogorized Maslows Hierarchy Theory of Needs into three simple categorized. They are, Existence Needs Relatedness needs Growth Needs Diagram 02 Existence Relatedness Growth Applying this into the Creative Solutions we can identify the most concrete needs and satisfy them. Existence needs are the most concrete needs and after satisfying them we can think about the next level and its automatically jump into the next level. In Herzbergs Motivation-Hygiene Theory, there are two kind of factors affect on motivation and they are Hygiene factors and motivators. Hygiene factors determine dissatisfaction and motivators determine satisfaction. Herzbergs theory confirms that only satisfaction can make a good productivity. Applying this to the Creative Solutions they avoid unpleasantness at work and create job satisfaction in the working environment. So its help to made a good service to the customer LO3.3 Motivational Theory for Managers (http://www.accel-team.com/motivation/, 2012) As a motivational theory Herzbergs Motivation-Hygiene Theory is suitable for the managers in Creative Solution. Applying this motivational theory to the Creative Solutions, it helps to motivate managers and get the best result from them. There are two factors in Herzberg theory, they are Hygiene Factors Motivational Factors Hygiene factor are those are essential in a work place. If its not entered to the work place, then they lead to the dissatisfaction. These factors describe the job environment/scenario. Hygiene factors include, Pay. Companies Policies and Administrative Policies. Fringe Benefits. Physical Working Conditions. Status. Interpersonal Relations. Job Security. And motivational factors are motivating the employees to the superior performance. Motivational factors are called satisfiers. Motivational factors include, Recognition. Sense of Achievement. Growth and Promotional Activities.. Responsibility. Meaningfulness of the Work. The Two-Factor theory implies that the managers must stress upon guaranteeing the adequacy of the hygiene factors to avoid employee dissatisfaction. Also, the managers must make sure that the work is stimulating and rewarding so that the employees are motivated to work and give their best to the organization. The job must utilize the employees skills and give a good compete to the competitors. Focusing on the motivational factors can improve work-quality. Task 02 HR Manager Presentation in Google Conclusion The purpose of this report understands the organization behavior in the world. It can understand how the organization using different organization structures, cultures, motivational theories and leadership styles. For that this report uses Google and Creative Solutions as the international and local company. So that itll help to understand how these two organizations uses different organization structures, cultures, motivational theories and leadership styles.

Pathology and Contemporary Treatment Alternatives

According to the Centers for Disease Control and Prevention, asthma is a complex disease on the rise in the United States. Most at risk include poor or inner city minorities that present with inordinately high rates of mortality resulting from the condition (CDC, 2005). Asthma may also be on the rise due to environmental factors including increased pollution and exposure to environmental toxins that may affect lung capacity (CDC, 2005; Hwang et. al, 2005; Yang, et. al, 1997; Wickman, et. al, 2003). Asthma is a serious, potentially life threatening condition for the millions of sufferers worldwide. Doctors are still working to determine the cause of this disease and finding new ways to treat it. While there is no cure for asthma yet, researchers have uncovered multiple treatment alternatives that help patients with asthma effectively control their condition. Education, public response and intervention are all critical success factors for predicting the quality of life for patients with asthma now and in the future. Research supports the use of a defined set of treatment protocols for assisting patients with asthma lead a better quality of life. The basis for treatment, anatomy and physiology of the respiratory tract and pathology of asthma in patients are all discussed in greater detail below. Normal Lung Function and Respiratory System The human body has two lungs located on either side of the chest. The lungs functions include passing oxygen from outside the body into our bloodstream and releasing waste materials in the form of carbon dioxide back into the environment (Gershwin & Klingelhofer, 1992). During each breath the body inhales oxygen and exhales carbon dioxide (Polk, 18). Oxygen combines with carbohydrates and fat in the body to product energy. During the process of creating energy water and carbon dioxide are formed that are expelled through breathing. The lungs consist of several anatomical structures including the bronchial tubes that enable expansion and constriction of the muscles in the lungs and chest. These tubes consist of muscles that allow air to pass deep in to the lungs. Bronchial tubes consistently change width, increasing in girth as an individual inhales and becoming narrower upon exhalation. In a person with a well functioning respiratory system all parts of the airway function synergistically to ensure maximum intake of oxygen and exhalation of carbon dioxide with each breath. Air enters the body through the nose and mouth. It passes through the pharynx, larynx and trachea, all important parts of the airway (Polk, 18). The noses and sinuses act as conditioners adjusting the air temperature as it passes through other structures in the airway. The pharynx or back of the throat allows liquids and solids entering the airway to â€Å"drop out before entering the lungs† (Polk, 19). Likewise the larynx helps prevent other unwanted particles in the air from entering the lungs (Polk, 19). It is here that the body's cough reflex lies. If something unwanted is present in the air being inhaled, the larynx will stimulate a cough reflex to help expel the object. While the larynx isn't the only trigger for a cough reflect it is very important to the entire breathing process (Polk, 19). When a person inhales, the chest muscles in the body contract allowing the ribs to separate slightly. Air is then drawn into the lungs. The opposite happens when an individual exhales, allowing air to forcefully come out of the lungs. The abdomen is also involved in breathing. The abdomen attaches to the front and back of the ribs, pushing them up and out when breathing. Breathing thus incorporates the chest and abdomen. The more a person engages all the muscles and organs involved in respiration including the abdomen, the better able they are to take a full breath of air. In times of old doctors ascribed asthma to anyone having difficulty breathing regardless of the cause; during the 20th century however researchers refined asthma to include difficult breathing â€Å"Because of a problem that begins in the bronchial tubes of the lungs† (Polk, 15). Asthma is a complex disorder that doctors are still working to fully understand. While doctors have uncovered many potential causes for asthma, they are still not certain what exactly causes it and how to prevent it 100 percent in all patients. In patients with asthma, the ability of the bronchial tubes to adjust their width is often diminished, resulting in difficulty breathing. Children are often at increased risk for developing asthma, as their bronchial tubes are narrower to begin with than adult tubes, thus less change in width is evident even in healthy lungs. Exercise induced asthma is a form of asthma that results when the air present in the nose and sinuses isn't prepared appropriately to pass through other parts of the airway (Polk, 19). Normally this form of asthma is easier to treat than severe forms of asthma whose cause is unknown (Hogshead, 1989; Guyton, 1991). During a bronchospasm attach involuntary spasms may prevent lung tissue from expanding to their normal size. Air can become trapped in the lungs. Cellular and structural changes often occur within the airway and lungs of patients with asthma, including thickening of the airway wall and inflammation (Saetta & Turato, 2001). Normally as air passes through the lungs the bronchiols or airways get smaller. In a patient with uncontrolled asthma however, the sides of the airways typically become enlarged or inflamed (CDC, 2005). During an acute attack, the muscles or bronchiols surrounding the airways constrict, thus reducing the amount of air a person can pass in and out of their lungs (CDC, 2005). Once this constriction begins, mucus starts forming in the airways, causing even greater constriction and distress. Typical symptoms associated with an asthma attack include wheezing, chest pain and tightness, coughing and difficulty breathing (CDC, 2005). No one is immune from asthma. Children, adults and the elderly are all at risk. Some people are more at risk than others including people who smoke, those with seasonal allergies and anyone with recurring acute respiratory infections (CDC, 2005). Signs of asthma include physical qualities of the disease a patient, family member or doctor can easily identify such as dyspnea (trouble breathing) (Polk, 7). Symptoms include complaints generally associated with the condition, and may include headaches or chest pain, skin flushing and itching (Polk, 8). Dyspnea results from multiple conditions other than asthma including infections, allergies, foreign bodies present in the airway and associated factors (Polk, 8). It is important a clinician differentiate between asthma and other causes of the disease. Basis Contemporary Treatments For Managing Asthma The National Asthma Education and Prevention Panel consistently work with doctors to develop contemporary treatments to manage asthma (Moonie, et. al, 2005). Many of these treatments are based on empirical research that supports reduction of patients symptoms and prevention of chronic attacks. The goal of contemporary asthma care and treatment includes â€Å"control of asthma and good quality of life for asthmatic patients† (Gaga, et. al, 80). The basis for much of contemporary care is empirical based research, though trends are changing in an attempt to encourage doctors to improve patient awareness and education. Many asthma drugs historically are administered through inhalation. Inhalers are often prescribed â€Å"on an empirical basis rather than on evidence based awareness: (Virchow, 24). Much of the asthma management guidelines currently available offer â€Å"non-specific advice regarding inhaler choice† (Virchow, 24). As such it is important that GP work with patients to decide what the ideal inhaler is for all patients involved. The ideal inhaler according to Virchow (2005) is one that (1) is breath activated, â€Å"releasing medication only when all prerequisites for successful inhalation are met, (2) has a low intrinsic airflow resistance so children and elderly patients may use it and (3) is one that provides a flow-independent deposition of drugs in the lungs as well as feedback that reassures patients whether the drugs has been inhaled properly (24). Newman (2005) suggests the pressured metered-doze inhaler or pMDI delivers asthma medications in a reliable â€Å"multi-dose presentation† (1177). Key components of this devices help determine the amount of drug delivered to the patient. The researcher further suggests that pMDIs can be developed that are breath actuated and coordinated with â€Å"spray-velocity modifiers† to help patients unable to use â€Å"conventional press and breathe pMDI's correctly† (Newman, 1177). Modern or contemporary pMDI's according to Newman should also contain non-ozone depleting propellants, a sentiment confirmed by Virchow (2005) as well. Patients with severe refractory asthma require more comprehensive treatment. High-doses of inhaled corticosteroids are often insufficient for treating this form of asthma. Most require contemporary treatments including oral corticosteroid administration and use of immunosuppressants (Sano, Adachi, Kiuchi & Miyamoto, 2005). Chronic use of these drugs however present a high risk for adverse side effects. A study conducted by Sano, et. al (2005) suggests that nebulized sodium cromoglycate â€Å"is expected to be a new second-line therapeutic option in severe asthma† (1). Gaga, et. al (2005) suggests that many doctors are not achieving good quality of life and control of asthma for patients. Their study of treatment outcomes for asthmatic patients in specialized care suggests that contemporary treatments should include more patient education combined with increased use of LABAs (Long-acting beta2-agonists) and leukotriene antagonists to help prevent bronchoconstriction and improve quality of life for patients. Despite multiple contemporary treatment choices, managing acute severe asthma attacks still present a tremendous health challenge to health care professionals (Barnard, 2005). Contemporary guidelines for treating acute emergency attacks currently include treatment with oxygen and inhaled beta 2 agonists, which can be administered continuously to help preserve life in acute patients (Barnard, 532). Patients discharged after such treatment should also engage in review of current medications and consider â€Å"a short course of oral steroids, a written asthma action plan and detailed advice about deterioration that may occur within 48 hours† (Barnard, 533). Butz et. al, (2005) are among a growing body of contemporary researchers that suggests that self management and patient education are critical success factors for treating patients with asthma in modern society. Their studies suggested home based educational programs that focus on accurate symptom identification and demonstration of â€Å"asthma medication delivery services† may improve patient quality of life and assist children with asthma and asthma like conditions (Butz, et. al, 190). Delaronde, Peruccio & Bauer (2005) find that â€Å"individualized telephonic case management† from registered nurses specifically trained in contemporary asthma treatment may improve asthma medication use and subsequent quality of life for patients with asthma (361). This research correlates with a growing body of evidence supporting patient education and direct support as practical contemporary treatment practices. The basis for much of contemporary treatment lies in the gold standards or clinical practice guidelines outlined by the National Asthma Education and Prevention Program's Expert Panel (CDC, 2005). These standards offer patients and health care practitioners specific guidelines for recognizing, diagnosis, treating and providing ongoing care to asthmatic patients. Because asthma is a difficult disease to diagnose, clinicians should utilize multiple diagnostic tools to determine whether airflow obstruction in patients results from asthma or other underlying conditions. Doctors should also acquire a comprehensive medical and family history and attempt to quantify the severity of a person's condition (CDC, 2005). Other contemporary diagnostic criteria helpful for assessing a patients condition include lung function tests (also referred to as spirometry) (CDC, 2005). Because there is no cure for asthma at this time doctors must work to improve the quality of life for patients presenting with asthma as effectively treat acute attacks. Doctors also work with patients to prevent attacks and recurrent episodes. Not one treatment modality works for all people because every case of asthma is unique. Because of this doctors often use various medications including injections, oral medications, vapors and inhalers. Use of inhalers to expand airflow is currently one of the most common and effective long-term treatment choices for patients with asthma. Contemporary long lasting medical treatments should include use of corticosteroids to help reduce inflammation in the lungs and airways. Most patients will inhale these medicines or take them orally. Long acting beta2-agonists are also identified as effective long-term treatments for patients with asthma. While inhalers, nebulizers and other medications all serve the asthmatic population, education should also form the foundation for modern treatment practices. Multiple researchers have concluded that patient education is effective for improving the quality of life in patients with asthma. Education also ensures that patients understand how to use their medications and do use them to prevent acute attacks. Education may be particularly beneficial for children by helping them adopt healthy behaviors early on that can help control their condition. Asthma is a complex disease involving structural and physiological components. Patients with asthma face a life long and often debilitating condition that under severe circumstances may result in increased morbidity. Fortunately there are many treatments currently available that effectively manage this condition. Contemporary management and treatment of asthma is based on empirical research that suggests multiple forms of medication for preventing and treating acute asthma attacks. The most common forms of treatment include corticosteroid administration through inhalers or oral forms. There are other equally effective medical treatments however that may work well for patients depending on the severity of their illness. No two patients are alike with respect to the condition thus treatment must be tailored to the individual. New research suggests that doctors and patients focus on prevention and education to help improve patients quality of life and experience of their disease (West, 1990). Education that starts early, as when patients are children, is likely to be more effective than education that starts years after an individual has attempted to manage their disease using other methods. Adequate evidence suggests that the manner of delivery for education does not impact a patients success rate. Thus information may be distributed in person, in the home or even over the telephone if necessary. The currently body of literature available suggest that education in the classroom may also be an important avenue for teaching prevention and treatment in the future (West, 1990). It is important that researchers and doctors continue exploring new avenues for treating and preventing this insidious disease. Pathology and Contemporary Treatment Alternatives According to the Centers for Disease Control and Prevention, asthma is a complex disease on the rise in the United States. Most at risk include poor or inner city minorities that present with inordinately high rates of mortality resulting from the condition (CDC, 2005). Asthma may also be on the rise due to environmental factors including increased pollution and exposure to environmental toxins that may affect lung capacity (CDC, 2005; Hwang et. al, 2005; Yang, et. al, 1997; Wickman, et. al, 2003). Asthma is a serious, potentially life threatening condition for the millions of sufferers worldwide. Doctors are still working to determine the cause of this disease and finding new ways to treat it. While there is no cure for asthma yet, researchers have uncovered multiple treatment alternatives that help patients with asthma effectively control their condition. Education, public response and intervention are all critical success factors for predicting the quality of life for patients with asthma now and in the future. Research supports the use of a defined set of treatment protocols for assisting patients with asthma lead a better quality of life. The basis for treatment, anatomy and physiology of the respiratory tract and pathology of asthma in patients are all discussed in greater detail below. Normal Lung Function and Respiratory System The human body has two lungs located on either side of the chest. The lungs functions include passing oxygen from outside the body into our bloodstream and releasing waste materials in the form of carbon dioxide back into the environment (Gershwin & Klingelhofer, 1992). During each breath the body inhales oxygen and exhales carbon dioxide (Polk, 18). Oxygen combines with carbohydrates and fat in the body to product energy. During the process of creating energy water and carbon dioxide are formed that are expelled through breathing. The lungs consist of several anatomical structures including the bronchial tubes that enable expansion and constriction of the muscles in the lungs and chest. These tubes consist of muscles that allow air to pass deep in to the lungs. Bronchial tubes consistently change width, increasing in girth as an individual inhales and becoming narrower upon exhalation. In a person with a well functioning respiratory system all parts of the airway function synergistically to ensure maximum intake of oxygen and exhalation of carbon dioxide with each breath. Air enters the body through the nose and mouth. It passes through the pharynx, larynx and trachea, all important parts of the airway (Polk, 18). The noses and sinuses act as conditioners adjusting the air temperature as it passes through other structures in the airway. The pharynx or back of the throat allows liquids and solids entering the airway to â€Å"drop out before entering the lungs† (Polk, 19). Likewise the larynx helps prevent other unwanted particles in the air from entering the lungs (Polk, 19). It is here that the body's cough reflex lies. If something unwanted is present in the air being inhaled, the larynx will stimulate a cough reflex to help expel the object. While the larynx isn't the only trigger for a cough reflect it is very important to the entire breathing process (Polk, 19). When a person inhales, the chest muscles in the body contract allowing the ribs to separate slightly. Air is then drawn into the lungs. The opposite happens when an individual exhales, allowing air to forcefully come out of the lungs. The abdomen is also involved in breathing. The abdomen attaches to the front and back of the ribs, pushing them up and out when breathing. Breathing thus incorporates the chest and abdomen. The more a person engages all the muscles and organs involved in respiration including the abdomen, the better able they are to take a full breath of air. In times of old doctors ascribed asthma to anyone having difficulty breathing regardless of the cause; during the 20th century however researchers refined asthma to include difficult breathing â€Å"Because of a problem that begins in the bronchial tubes of the lungs† (Polk, 15). Asthma is a complex disorder that doctors are still working to fully understand. While doctors have uncovered many potential causes for asthma, they are still not certain what exactly causes it and how to prevent it 100 percent in all patients. In patients with asthma, the ability of the bronchial tubes to adjust their width is often diminished, resulting in difficulty breathing. Children are often at increased risk for developing asthma, as their bronchial tubes are narrower to begin with than adult tubes, thus less change in width is evident even in healthy lungs. Exercise induced asthma is a form of asthma that results when the air present in the nose and sinuses isn't prepared appropriately to pass through other parts of the airway (Polk, 19). Normally this form of asthma is easier to treat than severe forms of asthma whose cause is unknown (Hogshead, 1989; Guyton, 1991). During a bronchospasm attach involuntary spasms may prevent lung tissue from expanding to their normal size. Air can become trapped in the lungs. Cellular and structural changes often occur within the airway and lungs of patients with asthma, including thickening of the airway wall and inflammation (Saetta & Turato, 2001). Normally as air passes through the lungs the bronchiols or airways get smaller. In a patient with uncontrolled asthma however, the sides of the airways typically become enlarged or inflamed (CDC, 2005). During an acute attack, the muscles or bronchiols surrounding the airways constrict, thus reducing the amount of air a person can pass in and out of their lungs (CDC, 2005). Once this constriction begins, mucus starts forming in the airways, causing even greater constriction and distress. Typical symptoms associated with an asthma attack include wheezing, chest pain and tightness, coughing and difficulty breathing (CDC, 2005). No one is immune from asthma. Children, adults and the elderly are all at risk. Some people are more at risk than others including people who smoke, those with seasonal allergies and anyone with recurring acute respiratory infections (CDC, 2005). Signs of asthma include physical qualities of the disease a patient, family member or doctor can easily identify such as dyspnea (trouble breathing) (Polk, 7). Symptoms include complaints generally associated with the condition, and may include headaches or chest pain, skin flushing and itching (Polk, 8). Dyspnea results from multiple conditions other than asthma including infections, allergies, foreign bodies present in the airway and associated factors (Polk, 8). It is important a clinician differentiate between asthma and other causes of the disease. Basis Contemporary Treatments For Managing Asthma The National Asthma Education and Prevention Panel consistently work with doctors to develop contemporary treatments to manage asthma (Moonie, et. al, 2005). Many of these treatments are based on empirical research that supports reduction of patients symptoms and prevention of chronic attacks. The goal of contemporary asthma care and treatment includes â€Å"control of asthma and good quality of life for asthmatic patients† (Gaga, et. al, 80). The basis for much of contemporary care is empirical based research, though trends are changing in an attempt to encourage doctors to improve patient awareness and education. Many asthma drugs historically are administered through inhalation. Inhalers are often prescribed â€Å"on an empirical basis rather than on evidence based awareness: (Virchow, 24). Much of the asthma management guidelines currently available offer â€Å"non-specific advice regarding inhaler choice† (Virchow, 24). As such it is important that GP work with patients to decide what the ideal inhaler is for all patients involved. The ideal inhaler according to Virchow (2005) is one that (1) is breath activated, â€Å"releasing medication only when all prerequisites for successful inhalation are met, (2) has a low intrinsic airflow resistance so children and elderly patients may use it and (3) is one that provides a flow-independent deposition of drugs in the lungs as well as feedback that reassures patients whether the drugs has been inhaled properly (24). Newman (2005) suggests the pressured metered-doze inhaler or pMDI delivers asthma medications in a reliable â€Å"multi-dose presentation† (1177). Key components of this devices help determine the amount of drug delivered to the patient. The researcher further suggests that pMDIs can be developed that are breath actuated and coordinated with â€Å"spray-velocity modifiers† to help patients unable to use â€Å"conventional press and breathe pMDI's correctly† (Newman, 1177). Modern or contemporary pMDI's according to Newman should also contain non-ozone depleting propellants, a sentiment confirmed by Virchow (2005) as well. Patients with severe refractory asthma require more comprehensive treatment. High-doses of inhaled corticosteroids are often insufficient for treating this form of asthma. Most require contemporary treatments including oral corticosteroid administration and use of immunosuppressants (Sano, Adachi, Kiuchi & Miyamoto, 2005). Chronic use of these drugs however present a high risk for adverse side effects. A study conducted by Sano, et. al (2005) suggests that nebulized sodium cromoglycate â€Å"is expected to be a new second-line therapeutic option in severe asthma† (1). Gaga, et. al (2005) suggests that many doctors are not achieving good quality of life and control of asthma for patients. Their study of treatment outcomes for asthmatic patients in specialized care suggests that contemporary treatments should include more patient education combined with increased use of LABAs (Long-acting beta2-agonists) and leukotriene antagonists to help prevent bronchoconstriction and improve quality of life for patients. Despite multiple contemporary treatment choices, managing acute severe asthma attacks still present a tremendous health challenge to health care professionals (Barnard, 2005). Contemporary guidelines for treating acute emergency attacks currently include treatment with oxygen and inhaled beta 2 agonists, which can be administered continuously to help preserve life in acute patients (Barnard, 532). Patients discharged after such treatment should also engage in review of current medications and consider â€Å"a short course of oral steroids, a written asthma action plan and detailed advice about deterioration that may occur within 48 hours† (Barnard, 533). Butz et. al, (2005) are among a growing body of contemporary researchers that suggests that self management and patient education are critical success factors for treating patients with asthma in modern society. Their studies suggested home based educational programs that focus on accurate symptom identification and demonstration of â€Å"asthma medication delivery services† may improve patient quality of life and assist children with asthma and asthma like conditions (Butz, et. al, 190). Delaronde, Peruccio & Bauer (2005) find that â€Å"individualized telephonic case management† from registered nurses specifically trained in contemporary asthma treatment may improve asthma medication use and subsequent quality of life for patients with asthma (361). This research correlates with a growing body of evidence supporting patient education and direct support as practical contemporary treatment practices. The basis for much of contemporary treatment lies in the gold standards or clinical practice guidelines outlined by the National Asthma Education and Prevention Program's Expert Panel (CDC, 2005). These standards offer patients and health care practitioners specific guidelines for recognizing, diagnosis, treating and providing ongoing care to asthmatic patients. Because asthma is a difficult disease to diagnose, clinicians should utilize multiple diagnostic tools to determine whether airflow obstruction in patients results from asthma or other underlying conditions. Doctors should also acquire a comprehensive medical and family history and attempt to quantify the severity of a person's condition (CDC, 2005). Other contemporary diagnostic criteria helpful for assessing a patients condition include lung function tests (also referred to as spirometry) (CDC, 2005). Because there is no cure for asthma at this time doctors must work to improve the quality of life for patients presenting with asthma as effectively treat acute attacks. Doctors also work with patients to prevent attacks and recurrent episodes. Not one treatment modality works for all people because every case of asthma is unique. Because of this doctors often use various medications including injections, oral medications, vapors and inhalers. Use of inhalers to expand airflow is currently one of the most common and effective long-term treatment choices for patients with asthma. Contemporary long lasting medical treatments should include use of corticosteroids to help reduce inflammation in the lungs and airways. Most patients will inhale these medicines or take them orally. Long acting beta2-agonists are also identified as effective long-term treatments for patients with asthma. While inhalers, nebulizers and other medications all serve the asthmatic population, education should also form the foundation for modern treatment practices. Multiple researchers have concluded that patient education is effective for improving the quality of life in patients with asthma. Education also ensures that patients understand how to use their medications and do use them to prevent acute attacks. Education may be particularly beneficial for children by helping them adopt healthy behaviors early on that can help control their condition. Asthma is a complex disease involving structural and physiological components. Patients with asthma face a life long and often debilitating condition that under severe circumstances may result in increased morbidity. Fortunately there are many treatments currently available that effectively manage this condition. Contemporary management and treatment of asthma is based on empirical research that suggests multiple forms of medication for preventing and treating acute asthma attacks. The most common forms of treatment include corticosteroid administration through inhalers or oral forms. There are other equally effective medical treatments however that may work well for patients depending on the severity of their illness. No two patients are alike with respect to the condition thus treatment must be tailored to the individual. New research suggests that doctors and patients focus on prevention and education to help improve patients quality of life and experience of their disease (West, 1990). Education that starts early, as when patients are children, is likely to be more effective than education that starts years after an individual has attempted to manage their disease using other methods. Adequate evidence suggests that the manner of delivery for education does not impact a patients success rate. Thus information may be distributed in person, in the home or even over the telephone if necessary. The currently body of literature available suggest that education in the classroom may also be an important avenue for teaching prevention and treatment in the future (West, 1990). It is important that researchers and doctors continue exploring new avenues for treating and preventing this insidious disease.

Culture Day Topic Essay

History of Judo was created by Jigoro Kano. He was a highly educated man; he was considered the founder of the modern Japanese education system. He wanted to preserve and combine the ancient martial traditions of Japan. One of the most important innovations was the emphasis of â€Å"randori†, or non-cooperative free sparring practice. The majority was based on pre-arranged sequences of attack and defense known as â€Å"kata†. For several years Kodokan Judo reigned supreme. Kudo was challenged by a man named Mataemon Tanabae. Maeda Mitsuyo Maeda became one of the greatest fighters in the history of Judo. Maeda retired without ever losing a fight. The Gracies, Maeda settled in Brazil and created an academy of â€Å"Jiu Jitsu†. One of his students was Carlos Gracie. After studying for several years he opened his own academy. He and Maeda created the â€Å"Gracie Challenge†, all challengers were welcome to compete in the challenge. The Gracie fighters were victorious against all kinds of fighters from different backgrounds. Several members of the Gracie family began to go to the US in the late 1980’s. The Gracies and their particular brand of fighting has had a major impact on martial arts today. Brazilian Jiu Jitsu Brazilian Jiu Jitsu was very similar in many ways with to Judo and other systems of Japanese Jiu Jitsu. Judo was originally designed as a powerful system of self-defense. Brazilian Jiu Jitsu is divided into three categories: self-defense, free fighting competition, and sport grappling. The fighting strategy of Brazilian Jiu Jitsu is to make a physically smaller or weaker person be able to defend from a larger or stronger attacker. When applying BJJ (Brazilian Jiu Jitsu) techniques leverage is key. As leverage is the secret to the most use of force.