Asthma Essay Example

Asthma Essay Example Asthma Essay Asthma Essay projected addition from 45 % at present to 59 % by 2025 in urban populations have been estimated. A attendant addition in the incidence of asthma is besides anticipated ( Bousquet et al, 2005 ) . The prevalence of asthma in the UK is peculiarly high with 5.2 million people affected ( Asthma UK, 2004 ) . It is of peculiar concern that asthma is now the major chronic unwellness of childhood with an norm of 15–20 % of kids in Europe being affected ( Smyth, 2002 ) compared with 8.6 % of grownups ( European Lung Federation, 2003 ) . The fiscal load of asthma in the European Union sums to about ˆ17.7 billion or ?12.1 billion yearly, and loss of productiveness due to hapless asthma control is estimated at ˆ9.8 billion ( ?6.7 billion ) ( European Lung Federation, 2003 ) ..The causes of asthma can be chiefly familial ( host factors ) although environmental factors can besides lend greatly to the etiology of the disease. Clinicians and research workers involved in asthma survei es resort to features of the disease that can be measured objectively, such as immediate allergy ( manifested as the presence of positive skin-prick trials or the clinical response to common environmental allergens ) , airway hyperresponsiveness ( the inclination of air passages to contract overly in response to triggers that have small or no consequence in normal persons ) , and other steps of allergic sensitisation ( GINA 2006 ) . The familial and environmental factors are besides though to act upon a person’s hazard of developing asthma. Disabling onslaughts of terrible dyspnoea, coughing, and wheezing triggered by sudden episodes of bronchospasm are common experience of patients with asthma. In some patients, the onslaughts may be triggered by exercising and cold or by exposure to an allergen to which the patient has antecedently been sensitized, but frequently no trigger may be identified. In add-on patients may be virtually symptomless between onslaughts ( Husain and Ku mar 2004 ) .PathogenesisThe major etiologic factors of asthma are familial sensitivity to type I hypersensitivity ( atopy ) , acute and chronic air passage redness, and bronchial hyperresponsiveness ( Husain and Kumar 2004 ) . The redness involves many cell types and legion inflammatory go-betweens(Vogel 1997 ) , but the precise relationship of specific inflammatory cells and the go-betweens to airway hyperreactivity is still non to the full understood ( Husain and Kumar 2004 ) . Type 2 assistant T ( THydrogen2 ) cells, a type of CD4+ assistant T cell, are outstanding constituents of the bronchial redness. THydrogen2 cells secrete interleukins that promote allergic redness and stimulate B cells to bring forth IgE and other antibodies. In contrast, type 1 assistant T ( THydrogen1 ) cells, the other category of CD4+ T cells, produce interferon-? and interleukin-2, which initiate the violent death of viruses and other intracellular beings by triping macrophages and cytotoxic T cells. These two subgroups of assistant T cells arise in response to different immunogenic stimulations and cytokines, and they constitute an immunoregulatory cringle: cytokines from THydrogen1 cells inhibit THydrogen2 cells, and frailty versa ( Fig.1 ) ( Schwartz 2002 ) . An instability in this mutual agreement is though to be cardinal cause of asthma ( Husain and Kumar 2004 ) .Figure 1:A simplified strategy of the system of type 1 assistant T ( THydrogen1 ) and type 2 assistant ( THydrogen2 ) cells. The distinction of THydrogen1 and THydrogen2 cells depends on interleukin-12 and interleukin-4, cytokines produced by antigen-stimulated precursor CD4 T cells. In a regulative cringle, interferon-? from THydrogen1 cells inhibits THydrogen2 cells and interleukin-4 from THydrogen2 cells inhibits THydrogen1 cells. An instability that favors THydrogen2 cells may be of import in asthma. Bronchial lymph cells from patients with asthma have been found to miss T-bet, a written text factor required f or the production of interferon-? ( IFN-? ) by ThymineHydrogen1 cells. (Husain and Kumar 2004 ;Schwartz 2002 )In add-on to the inflammatory responses mediated by THydrogen2 type cells, asthma is characterized by structural alterations in the bronchial wall, referred to as airway reconstructing. These include grounds for the proliferation of bronchial smooth musculus cells and deposition of sub-epithelial collagen ( Husain and Kumar 2004 ) .Atopic or allergic asthma, the most common type of asthma, normally begins in childhood. The disease is triggered by environmental antigens, such as dusts, pollens, carnal dander, and nutrients, but potentially any antigen is implicated. A positive household history of immediate allergy is common, and wheezing onslaughts are frequently preceded by allergic coryza, urticaria, or eczema. In any instance, a skin trial with the piquing antigen in these patients consequences in an immediate wheal-and-flare reaction, a authoritative illustration of ty pe I IgE-mediated hypersensitivity reaction. In the air passages, the scene for the reaction is set in big portion by initial sensitisation to inhaled antigens ( allergens ) , which stimulate initiation of THydrogen2-type cells that release cytokines such as IL-4 and IL-5. These cytokines, in bend, promote IgE production by B cells, growing of mast cells ( IL-4 ) , and growing and activation of eosinophils ( IL-5 ) . Subsequent IgE-mediated reaction to inhaled allergens elicits an acute response and a late-phase reaction ( Fig 2 ) .Figure 2:A theoretical account for allergic asthma.A, Inhaled allergens ( antigen ) elicit a ThymineHydrogen2-dominated response prefering IgE production and eosinophil enlisting ( priming or sensitisation ) .Bacillus, On re-exposure to antigen ( Ag ) , the immediate reaction is triggered by Ag-induced cross-linking of IgE edge to IgE receptors on mast cells in the air passages. These cells release preformed go-betweens that unfastened tight junctions bet ween epithelial cells. Antigen can so come in the mucous membrane to trip mucosal mast cells and eosinophils, which in bend release extra go-betweens. Jointly, either straight or via neural physiological reactions, the go-betweens induce bronchospasm, increased vascular permeableness, and mucus production and enroll extra mediator-releasing cells from the blood.C, The reaching of recruited leucocytes ( neutrophils, eosinophils, and basophils ; besides lymphocytes and monocytes signals the induction of the late stage of asthma and a fresh unit of ammunition of go-between release from leucocytes, endothelium, and epithelial cells. Factors, peculiarly from eosinophils ( e.g. , major basic protein, eosinophil cationic protein ) , besides cause harm to the epithelial tissue( From Husain and Kumar 2004 ) .In the instance of airborne antigens for illustration, the reaction begins with the sensitisation of mast cells on the mucosal surface following the inspiration of an allergen e.g pollen ; the end point go-between release opens the mucosal intercellular tight junctions and enhances incursion of antigen to the more legion submucosal mast cells. In add-on, direct stimulation of subepithelial vagal ( parasympathetic ) receptors provokes bronchoconstriction through both cardinal and local physiological reactions ( including those mediated by unmyelinated centripetal C fibres ) . This occurs within proceedingss after stimulation and is called the ague, or immediate, response, which consists of bronchoconstriction, hydrops ( owing to increased vascular permeableness ) , mucus secernment, and, in utmost cases, hypotension. Mast cells besides release cytokines that cause the inflow of other leucocytes, including neutrophils and monocytes, lymph cells, basophils, and peculiarly eosinophils ( IL-5 ) . These inflammatory cells set the phase for the late-phase reaction, which starts 4 to 8 hours subsequently and may prevail for 12 to 24 hours or moreThe late-phase reaction, as was noted earlier, is mediated by the drove of leucocytes recruited by the chemotactic factors and cytokines derived from mast cells during the acute-phase response ( Galli 1997 ) . However, go-betweens can besides be produced by other cells in the affected bronchial tube, including ( 1 ) inflammatory cells that are already present in asthmatics enduring a perennial onslaught, ( 2 ) vascular endothelium, or ( 3 ) airway epithelial cells. Epithelial cells are now known to bring forth a big assortment of cytokines in response to infective agents, drugs, and gases every bit good as to inflammatory go-betweens ( Shelhamer et al 1995 ) . This 2nd moving ridge of go-betweens stimulates the late reaction. For illustration, eotaxin, produced by airway epithelial cells, is a powerful chemoattractant and activator of eosinophils ( Lilly et al 1995 ) . The major basic protein of eosinophils, in bend, causes epithelial harm ( Shelhamer et al 1995 ) and airway bottleneck ( Costa et al 1997 ) . The presence of both immediate and delayed reactions in IgE-mediated events helps to explicate the drawn-out manifestations of asthma ( Husain and Kumar 2004 ) ..Clinical DiagnosisThe presence of cough, thorax stringency and wheeze ( normally diffuse, polyphonic, bilateral and peculiarly expiratory ) are a central marks of asthma. Measurements of lung map ( spirometry or peak expiratory flow ) provide an appraisal of the badness of airflow restriction, its reversibility, and its variableness, and supply verification of the diagnosing of asthma. Measurements of allergic position can assist to place hazard factors that cause asthma symptoms in single patients ( BTS/SIGN 2004 ) . Excess steps may be required to name asthma in kids 5 old ages and younger and in the aged, and occupational asthma. GINA ( 2006 ) guideline indicates that measurings of airflow restriction, its reversibility and its variableness are critical in set uping a clear diagnosing of asthma and underlie the new asthm a direction schemes advocated in current attention guidelines.Control MeasuresIt is ever cheaper and more effectual to forestall than to handle the symptoms of asthma. Preventive steps are normally taken by patients to avoid substances that might arouse an allergic reaction, this step will normally besides require that the patient controls his or her life or work environment to avoid allergen capable of arousing a reaction. A finding of the allergens or groups of allergens to which the patient is sensitive to is normally the first measure in preventative direction. Allergen may be easy evitable for illustration hair strands of cat, Equus caballus, Canis familiaris or bird plumes. There are persons who are allergic to nutrient additives or nutrient types such as caprine animal milk, nuts, strawberries and certain comestible oils ; others asthma patient are allergic to grasses, trees, harvests and flowers, fungous spores, aerosol sprays. Some allergens such as airborne environmental p ollutants are hard to avoid, others such as house dust touch are an built-in portion of day-to-day life for some patient. Preventive steps will in these instances be aimed at minimising instead than wholly avoid contact ( Thompson 1995 ) .Pharmacological interventions of asthmaThe end of asthma intervention is to accomplish and keep clinical control. Medicines that are available for the intervention of asthma can be classified as symptom accountants or stand-ins. Reliever medicines are normally used when needed such as when it is necessary to rapidly change by reversal bronchoconstriction and alleviate its symptoms. A figure of pharmacological drug categories may be classified as stand-ins, these include inhaled anticholinergics, short-acting Elixophyllin, rapid-acting inhaled i?2 agonists and short-acting unwritten i?2-agonists. On the other manus, accountant medicines meditates anti-inflammatory effects and are taken daily on a long-run footing to maintain asthma under clinical co ntrol. Inhaled and systemic corticoids, leukotriene qualifiers, sustained-release Elixophyllin, cromones, anti-IgE, long-acting inhaled i?2-agonists in combination with inhaled glucocorticosteroids, and other systemic steroid-sparing therapies may be classified as accountant medicines. The inflammatory response, attendant bronchial hyper-responsiveness, and variable airflow obstructor in asthma are extremely antiphonal to inhaled corticoids, positioning these drugs as first-line accountant therapy for this disease ( Holgate 2006 ) . Inhaled glucocorticosteroids are therefore the most effectual accountant medicines presently available ( GINA 2006 ; BTS/SIGN 2004 )Inhaled corticoidsInhaled glucocorticosteroids are presently the most effectual anti-inflammatory medicines for the intervention of relentless asthma. Surveies have demonstrated their efficaciousness in cut downing asthma symptoms, bettering quality of life, bettering lung maps, diminishing airway hyperresponsiveness, comman ding airway redness, cut downing frequence and badness of aggravations, and cut downing asthma mortality. However, when they are discontinued impairment of clinical control follows within hebdomads to months in a proportion of patients ( GINA 2006 ; BTS/SIGN 2004 ) .Most of the benefit from inhaled glucocorticosteroids is achieved in grownups at comparatively low doses, tantamount to 400 milligram of budesonide per twenty-four hours ( Powell and Gibson 2003 ) . Increasing to higher doses provides small farther benefit in footings of asthma control but in long term, increases the hazard of side effects such as easy bruising ( Mak et al 1992 ) , adrenal suppression ( Brown et al 1993 ) , and decreased bone mineral denseness ( Powell and Gibson 2003 ; Szefler et Al 2002 ; Pauwels et Al 1998 ) . However, there is marked single variableness of reactivity to inhaled glucocorticosteroids and because of this and the recognized hapless attachment to intervention with inhaled glucocorticoster oids, many patients will necessitate higher doses to accomplish full curative benefit ( GINA 2006 ; BTS/SIGN 2004 ) .Whilst inhaled corticoids are efficaciously front line drives in the control of asthma, non compliant usage of these groups of drugs will mostly take to intervention failures. How can asthma patients be helped to agree with the consistent usage of inhaled corticoids? First, we examine the issue of harmony ; thenceforth the treatment will concentrate on how several factors can be optimised to advance harmony.HarmonyThere are a figure of grounds why an asthma patient may non follow with therapy. In practical footings, this may go around around the belief about medical specialties in general troubles, for illustration that medical specialties are unnatural, ever with side effects or harmful ; such fright may be echt for inhaled corticoids therapy as there may be grounds to propose possible inauspicious consequence. The patient may fear that the therapy or drug will be ha bit-forming, or that their effects will have on off over clip. Asthma patients may besides neglect to follow with therapy if they lack equal information about their status and particularly about the importance of the therapy. It may besides be hard to foretell the conformity of an asthma patient if therapy interferes with his or her day-to-day life or as a consequence of age, some signifier of disablement or other fortunes or conditions, there is trouble in accessing medicine from the pharmaceutics, opening containers and efficaciously utilizing bringing devices or in retrieving to take medical specialties.As Marinker and Joanne ( 2003 ) justly puts it, the trouble for wellness professionals lies in admiting that it is the patients’ dockets and non their ain that determine whether patients take medical specialties. Patients have their ain beliefs about their medical specialties and medical specialties in general. They have their ain precedences and their ain rational discours e in relation to wellness and attention, hazard and benefit. These may differ from and sometimes contradict those of the physicians. They are, nevertheless, no less telling, consistent, or of import. Hence, it has in recent times become of import to look at patients’ failure to follow through with intervention as possibly a effect of the failure of the patients-prescribers relationship ( Marinker et al 1997 ) . Thus accent is now focused on a ensuring that a patient concurs with therapy as opposed to believing that he or she should adhere to intervention. The term harmony was introduced on the footing of these findings and penetrations ; it is a new manner to specify the procedure of successful prescribing and medical specialty pickings, based on partnership. While conformity describes the grade to which the patient follows the prescribed regimen of medical specialties, harmony describes an understanding between a patient and a healthcare professional about whether, when, and how medical specialties are to be taken. Concordance therefore refers to the creative activity of an understanding that respects the beliefs and wants of the patient, and non to compliance- the followers of instructions ( Marinker and Joanne 2003 ) . Annandale and Hunt ( 1998 ) express similar sentiments ; they suggest that many patients today will take intervention related actions based on informed determinations instead than following with medical advice or direction without oppugning every bit has been the instance in the yesteryear.Achieving harmony in Inhaled Corticosteriod therapyBy using the function of nursesOwing to the chronic nature of asthma, nurses are more likely to construct up a curative and swearing relationship over clip with their patient. This relationship is critical for the declaration of several issues related to harmony ; Barnett ( 2007 ) every bit highlighted the function of nurses in accomplishing harmony in patients with a similar chronic disease.Intellig ibly, asthma patients are more comfy in discoursing their concerns with nurses who by and large have more cognition of the assorted asthma interventions and inhalators available than many general practicians. Again this may non be unrelated to the greater contact nurses make with these patients. Practice nurses and respiratory nurse specializers besides tend to hold longer clip slots than General Practitioners or advisers in a busy outpatient clinic, and are hence able to supply the relevant cognition and information related to the patient’s status and explicate the principle for the intervention prescribed ( Barnett 2007 ) . Nurse-led clinical intercessions and place visits by specializer nurses combined with educational programmes have showed important benefits in cut downing readmission rates and bettering harmony ( Sayer, 1999 ) . In pattern, accomplishing harmony in inhaled corticosteriod therapy will necessitate a assortment of accomplishment of clinicians and possibly several good individualised as no one size can suit all.By optimizing patients’ apprehensionWhen patients are good educated about their asthma and therapy, they are more likely to follow with their intervention. It is important, possibly cardinal for clinicians non to presume at each audience. Clinicians should needfully measure and set up what an asthma patient understands about the cause/s, triggers or annoyances of his or her status and symptoms, every bit good as the cognition he or she have in relation to his or her medicine and the direction of his or her status. One manner to salvage on clip that such as an effectual audience will affect is to roll up outstanding patient and intervention advancement information prior to audience. A questionnaire may be sent out to patients ; this should be returned and evaluated before existent audience. The questionnaire should be able to uncover any cognition spread in patient’s apprehension and besides measure the patientâ₠¬â„¢s single demands sing the information they require to enable them to self pull off their disease with inhaled corticoid therapy.At each audience it is good pattern to promote patients to convey along their inhalators and a list of the medicines they are taking, and to double-check this against their printed prescription. Finding out precisely in what manner, when and how the patient is taking all their prescribed medicine utilizing open-ended inquiries is really of import. For illustration, Can you state me when and how frequently you use your Pulmicort through your turbohaler? ’ instead than taking the patient by inquiring: Do you take two whiffs of your turbohaler four times a twenty-four hours ( when you get up, at lunch period, afternoon tea and bedtime and if you get dyspneic in between following effort ) ’ ? A patient is more likely to merely state YES’ to the latter inquiries since this agrees with the heath professional’s outlook, therefore su ch type of inquiries do non let for an accurate appraisal of patient competences in utilizing their inhalator and will forestall insight into possible issues that the patients may hold with the corticoid itself. The audience can besides be used to measure if the patient’s inhalator technique is equal, and if it is non, to discourse an alternate device if they are fighting to trip or organize the 1 they have. From experience, if the patient is able to utilize their inhalator efficaciously, has assurance in the device and later obtains benefit or alleviation, they are more likely to be accordant with their intervention ( Barnett 2007 ) .Current BTS/SIGN ( 2004 ) every bit good as GINA ( 2005 ) guidelines on the direction of asthma recognize that every asthma audience is an chance to reexamine, reinforce and widen both cognition and accomplishments of patients. No uncertainty, it is besides reassuring for patient to experience the attention and understanding of their attention s uppliers, as this will rapidly prosecute their cooperation for the success of therapy. It is good for wellness attention professional to explicate to patients that they are acute to cognize if inhaled corticosteriod therapy is truly good to the patients, attempt should be made to measure consequence of the therapy on patients’ life style every bit good as quality of life. Consultations are besides a good juncture to promote patients’ remarks on emotional or other non-medical factors that may forestall the patient from genuinely agring with therapy. It is critical that the ambiance is really relaxed since clinicians want the patient to freely volunteer information that are of import and besides want to negociate an understanding that the patient will lend actively to the success of the therapy.By effectual communicatingIt can be hard sometimes to make up ones mind how much information to give single patients, bearing in head that most tend to retrieve merely 50 % of the information given during a audience. Therefore, it is imperative that the information provided is personalized and good spaced over and delivered in patient friendly linguistic communication. It ever helps to utilize ocular AIDSs and coloured diagrams to enable the patient to associate to and understand the information given. Simple accounts are best, being specific and sum uping at the terminal of the treatment, which is supported by cusps for the patient to take away, if appropriate. It is besides utile to compose drug regimens down utilizing simple image charts or written instructions bespeaking times and doses of the inhalator prescribed to assist those patients who are prone to forgetfulness or confusion over when to utilize their inhalators and in what sequence ( Barnett 2007 ) .Key end for the control of asthma include 1 ) minimal symptoms during twenty-four hours and dark ( 2 ) minimal demand for reliever medicine ( 2 ) no aggravations ( 3 ) no restriction of physical activ ity ( BTS/SIGN 2004 ) . Cardinal to this end is the asthma patient’s to agree with chosen intervention or direction options. For the most portion, this can be achieved through holistic nursing attention. Thompson ( 1995 ) suggested that this signifier of nursing asthma patients will include: ( 1 ) proviso of instruction about asthma ( 2 ) the publicity of self-management and ( 3 ) the proviso advice and support. Asthma patient instruction should non be aimed at merely leaving medical facts but to learn and pass on efficaciously with a position to advance harmony. Nurses spend an tremendous sum of quality with patients ; these together with their supportive attitude to patients can be put into optimum usage to further harmony in inhaled corticosteriod therapy. Surveies have similarly shown that nurses are good placed to accomplish these ends ( Mathieson 1992 ; Wilson-Barnett and Osbourne 1983 ) .Listen twice every bit muchIn kernel, until single patients’ concerns are a ddressed, they may stay loath to take their intervention as advised until they feel satisfied with the account given or have a better apprehension of their disease and intervention. Health professionals, hence, have an of import function to play in actively listening to their patients’ concerns or specific grounds as to why they are non taking their medicine as prescribed ( Barnett 2007 ) . Figure. 3Self regulative theoretical account from Cameron 2003 Patients’ representations of unwellness ( Fig 3 ) as defined by Cameron in ( 2003 ) may be adapted for the chronic status of asthma. Cameron ( 2003 ) defined such readings as a patient s ain implicit, common sense beliefs about their unwellness. In explicating how a patient might see his or her unwellness, Cameron ( 2003 ) suggested that patients’ thoughts about their unwellness may be clustered around a figure of constituents which may include the following for an asthma patient: The societal or general label of asthma and the symptoms the patients view as being portion of asthma. Patients’ positions about what may hold caused their status of asthma, such as familial factors, hapless diet, injury, allergens etc. Patients’ position about how long their job will last and whether it is seen as, chronic or episodic. Consequences: these include the effects asthma patients are anticipating from their unwellness and their positions on the result. Cure/control: Asthma patients’ outlooks as they control their asthma. These constituents are none inactive, for illustration Cameron ( 2003 ) opines they are likely to be influenced by the therapy the patients receive and these positions will in bend influence their perceptual experiences of therapy. However, these constituents make up the patients’ overall perceptual experience of their unwellness and it is utilizing this perceptual experience that the patients try to understand their unwellness, figure out how long it might last, make up ones mind what caused it, etc. It is likely that this perceptual experience may besides find how the patient positions therapy and how good they comply with intervention governments ( Cameron 2003 ) . Understanding how an asthma patient might ground out and accommodate or subject to his or her status is hence cardinal to the success of any attempt to accomplish harmony in inhaled corticoid therapy.For case, asthma patients are frequently concerned about the side or even inauspicious effects of inhaled corticoi ds. In pattern, many of these patients frequently fail to distinguish between the side effects of inhaled corticoids and those originating from the long-run usage of unwritten corticoids. It will be hard to accomplish harmony in these patients if such fears’ are non efficaciously allayed. Keeping harmony in these patients will amongst other factors depend on changeless reassurance of the comparatively low hazard of inhaled corticoids. It might be helpful to reassure these patients that the sum of steroid that gets into the blood stream via the inhaled path is really minimum and is improbable to bring forth any important systemic effects. Using a spacer device and gargling afterwards can greatly cut down any side-effects such as gruffness, oral cavity or pharynx infections that may ensue from inhaled steroids every bit good as increasing drug lung deposition. Additionally, the prescription of steroid saving medicines such as long moving bronchodilator or a leukotriene receptor adversary may be considered if clinical appraisals reveal marks or symptoms of existent concern. Wherever possible, clinician should endeavor to put patients on simplified dosage and government of inhaled corticoid. Patients may besides worry about other side effects which they read about in the cusps supplied with medicines or on the cyberspace or are told by friends and relations. In general, discoursing options or seeking solutions with the patient can easy turn to these concerns ( Barnett 2007 ) .Teenage or stripling asthmatics are a alone group of asthma patients for which it may be hard to accomplish harmony in inhaled corticoid therapy. Again, a careful consideration of the patient factors normally involved is deserving sing. The reappraisal of an asthma teenage patient by Cuffwright ( 2001 ) shed visible radiations on issues that virtue careful consideration if harmony is to be achieved in these patients. Adolescents strive to accomplish independency yet audiences largely t ake topographic point with a parent. Sensitive issues like this should be decently handled. Clinicians should move as to bespeak that they recognize that this patient group can every bit be responsible for the direction of their status with small or no support from their parents. A successful scheme has been to personally prosecute them in an grownup relationship within which they can get down to do their ain determinations ( Townsend et al, 1991 ) . Teenage asthmatics should therefore be actively involved in the control of their wheezing and be commended for any mile rock accomplishment in attention program. When attention options are discussed straight with teenage asthmatics and understanding reached through dialogue, they are less likely to yield to peer-pressure inauspicious risk-taking behavior. Most adolescents regard asthma as episodic and accept the demand to regularly usage an inspiration preventer. However, pattern nurse needs to inquire these patients about how they trul y feel about inhaled corticoid. Young asthma patients may confound corticoids with anabolic steroids used by jocks ; it is therefore of import that the perceptual experience of single patients within this age group is assessed and ins

Back-to-School Student Questionnaire

Back-to-School Student Questionnaire One of the challenges of starting a new school year is getting acquainted with your students. Some students are friendly and talkative right away, while others may be shy or reserved. Provide students with a back-to-school questionnaire to learn more about each student in your class. You can also combine student questionnaires with other icebreakers during the first week of school. Sample Student Questions The following questions are some examples to consider including in your own questionnaire. Modify the questions to suit your students grade level. If you need a second opinion, run your questionnaire draft by an administrator or a fellow teacher. You dont need to have students answer every question, though you might want to give them an incentive to participate. And remember, students want to get to know you better, too- so fill out a questionnaire of your own and distribute it. Personal Details What is your full name?Do you like your name? Why or why not?Do you have a nickname? If so, what is it?When is your birthday?Do you have any siblings? If so, how many?Do you have any pets? If so, tell me about them.Who is your favorite relative? Why? Future Goals What career do you hope to have?Do you want to go to college? Why or why not?If you want to go to college, which one do you want to attend?Where do you see yourself in five years? Ten years?Do you plan to stay in this area or move away? Specific Information About This Class What do you think about [the grade level and/or subject matter you teach]?What concerns, if any, do you have about this class?What do you hope to learn in this class?What grade are you striving to earn in this class? This Year in School What are you most looking forward to this year?What are you least looking forward to this year?Which school clubs are you planning to participate in this year?What extracurricular activities do you plan to join this year- such as sports, theater, or band?Do you think that you learn better by seeing, hearing, or doing something?Do you consider yourself well organized?Where do you typically do your homework?Do you like to listen to music while you do schoolwork? Free Time Who are your friends in this class?What do you like to do in your free time?What are your hobbies?Whats your favorite type of music?Whats your favorite TV show?Whats your favorite type of movie? (For example, you might choose thrillers, romantic comedies, or horror movies.) Why do you like that genre? More About You Whats your favorite color?If you could invite three famous people to dinner, who would they be and why?What do you think is the most important quality that a teacher can have?Five adjectives that describe me are:If you were given a first-class ticket to travel anywhere in the world, where would you go and why?

Social media critical analysis Essay Example | Topics and Well Written Essays - 750 words

Social media critical analysis - Essay Example There are several instances where differences arise in the way people perceive others, something that has resulted in ethnicity, racism and other perspectives that carry negative impacts and connotations. This paper examines the issue of racism and ethnic connotations that are continually becoming the main agenda across social media and other platforms in the society. It focuses on how these thoughts and perspectives are taking toll on the society and the perceived implications they are creating, as well as steps being taken to create a cross-cultural social platform. In our contemporary society, ethnicity is standing out as the cause of disagreements across human societies. Our society penalizes people that openly talk about racial issues; these gaps provide perfect grounds upon which honest conversations effecting their particular communities are raised (Miller 3), this statement continues to elicit mixed reactions across many platforms. Currently, marketers across the business world are realizing the need to make objective communications in order to attract clients that have different origins in terms of their ethnic affiliations, race and preferences. This is because; businesses create products that are destined to fulfill the needs of all people in the society irrespective of their differences. This has yielded efforts and strategies in creating a non-polarized media that appeals to all the needs of the different groups of people for all the good reasons. While marketers have been making efforts in dropping their long-held traditional ethnic media, they are scrambling to establish a platform that is cross-cultural, and lacking ethnic connotations. These efforts are expected to eliminate the hate and related outcomes that are often brought about by ethnic connotations and perspectives that people hold in the physical societies that we live in. Currently, people want to be associated with others of their own race, ethnicity,

COMMUNICATION Essay Example | Topics and Well Written Essays - 750 words

COMMUNICATION - Essay Example In a group situation, I will listen mostly and will intervene only when someone is providing misinformation. When I know that the person with whom I am conversing is more knowledgeable, I prefer to listen and will not like to give suggestions, unless specifically asked to do so. Do I ?nd it necessary to use many descriptive terms when speaking, or do I prefer short, succinct sentences? I prefer to use short sentences. Being a listener by nature, in my style of conversation ears will be better engaged than the tongue. In my replies I prefer to be crisp, may not be witty, but I will answer to the point, nothing more, nothing less. Time is precious and I will not like to waste the time with whom I am conversing, nor like to allow him to waste my time. I will not sermonise on a topic on which I do know much about. I like to be brief. Do I prefer cause-and-effect situations as opposed to creative, ambiguous dilemmas? I do prefer cause and effect situations and I do not like dilemmas or co nfusion. While conversing, I have in the back of my mind invariably that I need to concentrate on the essence of the issue, and not talk in a roundabout way. When I say something and answer about a particular issue, it must be based on reasoned premises. I hate creating dilemmas and confusing situations. The purpose of a conversation (unless it is a formal and casual talk) is to find an acceptable solution, and as such there is no point in getting more and more confused. Do I prefer to be alone or be with others? I prefer to be alone. I do not like promoting myself, speaking up and networking. My philosophy of life is to ‘talk less, work more and walk more’. I am an introvert. I do believe that brazen confidence is not the exclusive property of the extroverts and introverts too are entitled for that. I entirely agree with the observation â€Å"introverts prefer less stimulating environments and tend to enjoy quiet concentration, listen more than they talk and think bef ore they speak†. (Jenna Goudreau, n. p.)Historical information provides strength to my position as some of the ideas for big innovations and great leadership come from introverts. Unless there is a cause or a common purpose, engaging in directionless and destination less conversation is waste of time, and as such I enjoy my solitude. Do I prefer to make decisions alone, or do I prefer to work things out with others? I do like to work things out alone, but I do also like to ask others for opinions, as I believe that a person should not make important decisions alone. The wise saying goes ‘Two heads are better than one’. Decisions taken by sharing knowledge are likely to fructify and give positive results. Each individual may have expertise in a particular area, and in the environment of a big hospital, one has to work in different situations. So, when a critical decision needs to be made, that has bearing on the life of the patient, I consider it my professional du ty to take a decision in consultation with my experienced colleagues. Sharing information and taking counsel from others has only advantages and no disadvantages. Summary of my communication style I have my nursing job; I have a family to take care; I have my friends circle; I am part of the society, a cultural and religious group. As such my communication

Gambling should be legalized Essay Example for Free

Gambling should be legalized Essay What is gambling? According to www. dictionary. com gambling is taking a risk in the hope of gaining an advantage or a benefit. Gambling has been around for centuries and has been dated way back to 1492. People have been gambling in America ever since America was found. There are numerous underground cards clubs and casinos all over the country and in major cities. People gamble on everything: sports evens, dice, and cards. Even though people gamble every day in the United States, it is still illegal. People do gamble everyday, so why is it not legal. Gambling should be legalized. There are tons of ways to gamble. Anybody can pretty much gamble or make a bet on anything. Some major games though are cards. People play games such as poker or blackjack. Also, betting on horses and dogs has been around quit a bit. The biggest form of gambling though is the lottery. Most of these games and events are already legal such has the track and the lottery, but why are regular games like poker and blackjack illegal? Why gamble? What good can come from gambling? Gambling can help our economy by keeping money here in out on state. Proponents say it keeps money in the state (Legalized Gambling 2). Another huge reason on why gambling should be legalized in the fact that it would draw a huge number of tourism to our state. It could also attract potential tourist to the area. Tourist with money to spend, not just in the casinos, but at local restaurants, hotels and shops (Legalized Gambling 2). This statement not only proves that it would bring tourist, but also that the local area would thrive as well because tourist would be spending money at other places such as hotels and restaurants. It would make the state richer. Why not gamble? According to the Legalized Gambling article in paragraph three some people say that gambling would increase crime, which in return would mean would need more police and more money spent on the police. Many feel that casinos will cause an increase in crime which means increased money spent on police (Legalized Gambling 3). Many say it would cause people to become addicted, and the homes and families of these people would be ruined. Some also believe that more Arkansans will develop gambling addictions which will lead to decay in the homes of these people and a general decay of family life in Arkansas (Legalized Gambling 3). Although this article in referring to Arkansas, the points are very relative to our state of Pennsylvania. If gambling were legalized, there would be more jobs. Jobs are very important especially now in our society. Hundreds of people do not have jobs. Jobs will be open for new casino card dealers for example. More transportation will be need for people to get to the casinos, and since there will be more people coming we will need transportation to other areas as well. Also, the local businesses like hotels and restaurants will be booming. As a result, more jobs will be needed to up keep these facilities. Not only will gambling supply more jobs, but also the local taxes will go down. All gambling winnings are taxable. When a person wins the World Series of Poker, the winnings are taxed. Also, the casinos will have to pay taxes, which will result in lower taxes such as school taxes and so forth. This will keep most of the money in the state as well. Over in Jersey, gambling was one of the main sources of income for the state back in 1857. Legal gambling has become a $10 billion industry in New York, New Jersey, and Connecticut, and the states, which are collecting $500 million a year in gambling revenues, are becoming more dependent on it to balance their budgets (Janson 1). Back in 1857 the economy was bad but gambling didnt even become stunned by the economy. Despite a clouded economy, wagering is up in all three states in each of the last three years in almost every form of legalized gambling (Janson 2). Back then it was making a killing. We can only imagine what it is bringing in now. Gambling is the sole reason to go to Las Vegas. Who would want to go a desert on vacation where temperatures can get into the hundreds? Gambling is the only thing that is going for Las Vegas. With out gambling no one would go, and look at how much money Las Vegas is bring in off of the tourists coming from all over the world, all because of gambling. So when people do gamble where does the money go? Where gambling in legal money gets divided up. 84% returned to the public, 15% for commission, and 1% breakage or surplus (Freeman 167). This shows that at the racetracks 84% go back to the people who are gambling, 15% goes to the brokers, and 1% is the breakage or surplus. That is how the money works in the racetracks. Each state deals with the money differently though. These percentages include the deductions for monies for both Track and State. Each state has laws specifying the division of this percentage between Track and State. Some states use a sliding scale. The higher the volume of business, the higher the percentage paid to the state (Freeman 166). As shown here the state taxes are included. Also, commission is used in all racetracks, and this provided jobs for many people. Another good reason why gambling should be legalized is because people can make a ton of money. If people would be smart about things they could maximizes their profits. These people are called pros. Professional poker players, like Johnny Moss, make all their money from playing cards. Gambling, if done right, can be easy pickings for people. Gambling is a calculated technique for making money (Thompson 27). Basically this is saying that if people are not stupid with their money that they will win. For example, if a person is playing Texas Holdem, a type of poker, then they should only play superior starting hands like Ace King, or Ace Ace. The reasoning behind this is because these starting hands have the best odds or chances of winning. By calculating odds people can beat the game. As mentioned before, gambling can be beat. A good way to make money is to play games where the people have control. Luck can only take a person so far. In casinos, most of the games, like the slot machines and roulette, have odds favoring the house or the casino. It is wise to stay away form these games. Instead, people should play poker or blackjack, where there is a little more skill involved. Luck can only take a person so far. According to Basil Nestor Luck has an influence, but skill has a more pronounced effect (13). This means in the long run, skill will produce more money. In card games there is a rake. The rake is a percentage of the winnings that goes to the house or casino. This is how the casino makes money of the game. For example, if a person just won a $100 pot in poker and the casino rakes ten percent, then that person would only get $90. Another nice thing about casinos is that the more a person gambles, the more they will get. Casinos always give out free things. For the high rollers, or people that spend a lot of time and a lot of money gambling, casinos usually give them free rooms and free tickets to shows. If a person is doing well, the casino may give them free food or free money to play with. There reason for this is to keep that player there. Statistically, the house or casino has better odds, meaning that the chances of a person winning are lower than even. So, eventually the casino will win. So, they try to keep that player there for as long as they can because they think the odds will catch up with them, but as mentioned before there are ways around that Gambling will help our state out tremendously. The state could use more jobs. Some taxes will go down. It just seems to be a no brainer. Why would we not legalize gambling? People say that it will ruin homes and lead to addiction. Well, for all those people that are concerned about that, dont gamble. No one will twist your arm to gamble. Gambling will bring so much to the state of Pennsylvania. All the tourist will need a place to stay. Thats where our local hotel and motels come in. The business will increase drastically. All the tourists will need a place to eat. Our restaurants will serve that purpose. With all this, all these businesses will need to up keep with everything. So, as a result, there will be more jobs available. The casinos will also cause taxes to go down. With all the money the state will be receiving from the casinos, they wont need to tax the people of the state. We already have the lottery and bingo and, these are forms of gambling. How come the lottery and bingo are exactable to our society and games like poker and blackjack are not? Is there that much of a difference? Gambling will do more good than bad.

Dreams in Death of a Salesman. Essay -- English Literature

Dreams in Death of a Salesman. In this essay I’m going to consider Arthur Miller’s perception of dreams, particularly the American Dream. Arthur Miller's play "Death of a Salesman" is a detailed review on the capitalist American society of the 1940s and also on human psychology and how much materialistic success means to us. He uses the misfortunes of a salesman named Willy Loman to illustrate this. Miller introduces the Loman family in a depressing mood (dim lighting is used and shows a house that has "towering, angular shapes" surrounding it and with little furniture). This immediately gives the audience a glum feeling about the play. The Loman family is a very stereotypical American family, with the father, Willy, working all day, a loving mother, Linda, and two children, Biff and Happy. As the play develops however, we learn more and more about the real tragedy of the family. Willy believes in the American dream. It was very influential in the American society of the 1940s and still is to some people, today. But only a few people have benefited from it. The American dream is based on the idea that as long as someone works hard, they will achieve great success no matter what their sex, age, nationality is. As the audience learn about the Loman family's poor financial situation, it becomes clear that Willy is a victim of the American dream. Willy's failure in leading a rich or even just a comfortable life is very apparent. He complains about his work and struggles to pay his bills. He is also frequently shown in a state of depression, he cannot concentrate when driving; he is still working at his old age and is struggling to bring in a steady income. His unstable mind makes him contradict himself in th... ...fridge fails. Arthur Miller seems to see her, not Ben, as the real hero of the play. This is reflected in the gentle respect he gives to her in his writing. This play is a strong message against the principle of the "American Dream". Willy Loman is constantly striving to achieve the dream, but drives himself crazy. Biff seems to be the only character in the Loman family that is able to set himself aside from this dream, wanting only to be happy - his own man. Although I believe dreams to be an important, if not essential part of life, I also believe that contentment is far more important. If you cannot be happy with what you have, you cannot possibly hope to be happy with what you wish for. Willy Loman dreams of becoming a great man, dreams of the great man he was and dreams of the great man Biff can be, he just fails to realise that they are great men.

A Rose for Emily: Emily as a Tradition, a Duty and a Care Essay

Emily Grierson is the title character in the short story â€Å"A Rose for Emily.† The narrator portrays Emily as a â€Å"tradition, a duty, and a care,† (Faulkner,79) but in her actions, it is obvious that Emily is a true outsider. She shuts out the townspeople, only allowing them to see certain aspects of herself and leaves them to speculate the rest. She lives with her father until his death. Any chance at love for Emily was denied due to her father driving potential men away so that he could have her all to himself. Having been sheltered and secluded by her father, she continues to lead that kind of lifestyle after his death. Miss Emily’s home fits in with her character. Both are dark and mysterious. Emily rarely lets people into her life to see the real her so she remains dark and mysterious. Her home is also closed off to the townspeople. She rarely allows people into her home, and those that do find it layered with dust. The house is also falling into decay which also coincides with Emily’s aging and bloated and pallid appearance. It is clear that Mr. Grierson was extremely controlling of Emily. He showed this in his attempt to drive potential suitors away. After his death, Emily attempts to take control by denying that he has passed and refusing to give up his body. Before they can resort to using the law to take his body, Emily finally gives in and releases the body to them so that he can be buried properly. The townspeople are not surprised by her actions. They felt it was something she needed to do because she had nothing left, so she had to cling to the one thing she did have, and that was her father. Miss Emily follows her own rules. She does not abide by the law like everyone else. A deal had been made that she didn’t owe any taxes. Colonel Sartoris told her it was because her father had loaned the town money and therefore the taxes were remitted. When a new generation took over and sent her a bill, she either ignored it or sent back the bill with a note. When they came to her home to talk to her about it, she still adamantly refused to pay the bill, telling them she owed none and to speak to Colonel Sartoris about it. Even though the Colonel had been dead for ten years and there was nothing in the books to show that the taxes were remitted, she refused to accept the new authorities and has them shown out. She also refuses to put numbers on her mailbox when federal mail is put into place and in stating why she is buying the poison. No one ever pushes her and forces her to follow the law, it is as if they are afraid to question her or just ignore her eccentricity. They even refused to bring the multiple complaints of a bad smell to her attention and instead snuck into her yard at night, breaking open the cellar door to sprinkle lime in there as well as in all the outbuildings. No one wanted to â€Å"bother† Miss Emily. Eventually a man named Homer Barron comes to town. He begins to spend time with Miss Emily. At first the townspeople are happy that someone has piqued her interest. Many thought that they would eventually marry, even though Homer states that he is not the marrying kind. Many feel that she will find a way to persuade him to marry even though it seems as though he is interested in men. Eventually, the townspeople all believe that they will soon be married because of items that Emily buys for Homer. Homer leaves at one point while Miss Emily has family visiting. The townspeople see him return, but it is the last they see of him. This is when Emily’s failure to follow the law takes a turn. She was never questioned on why she needed the arsenic. It of course gets around town that she has purchased it, and they all believe she will kill herself. Even though Homer is never seen again and even though her home is mainly closed up until her death, except for the few years she teaches china painting, no one ever thinks that the arsenic is being used in a more sinister way. After Miss Emily’s death, the townspeople come to pay their respects. The men do so more out of respect while the women are more interested in seeing her home after all these years. It is soon discovered that Homer Barron’s dead body is lying in a bed in one of the rooms. Next to his body, on the pillow, it is clear that Miss Emily has spent time laying there beside him. It is clear that Miss Emily couldn’t bear the thought of Homer abandoning her, so she poisoned him so that she would always have him with her. She clung to him just as she had her father, but this time she found a way to make sure Homer would not be removed from her home. No one ever calls Miss Emily crazy, even though she had a great aunt that had gone crazy. All her actions are just thought of as part of her eccentric ways. No one thinks to question her or what she does. It is clear that Emily is suffering from some sort of mental illness. She clearly shows she has abandonment issues after being sheltered by her father. She refuses to accept or reveal his death until forced to do so. It is also clear in her actions of poisoning Homer Barron. After her father’s death, the narrator states that â€Å"she was sick for a long time after that.† It seems as if maybe she had some sort of mental breakdown after she is left alone. If only her father hadn’t sheltered her so much and refused to allow her to find love and seek friendship, she would not have acted in such desperate ways. If she could have gotten help to get over her fears or was able to talk to someone about it, maybe Homer would not have been poisoned. Although her actions and the outcome were tragic, in a way you have to feel bad for her because she was following the example that her father set for her. He desperately clung to her and in turn, she desperately clung to the men she cared for.

Report Writing on a Paintball Game

Yesterday at 3:30 pm was Jonny’s last strike as he had shot his mother. This action had only seemed as an accident, but as we confronted him it would only seem as an unlikely act that had taken place because of the objective of the game, or is it? Tune into the rest of this article to find out the real objective behind this setup. The legendary twenty-first century game of paintball co-exists as a way of enlightening the players of the dangers of being at war. The fun loving sport is a thrilling experience one should have if he is able to.The sport requires excellence in agility and the ability to make decisions on a quick note, as well as teamwork risking the life of others. Paintball technology is also used by military forces, law enforcement, Para-military and security organizations to supplement military training, riot response, and non-lethal suppression of dangerous suspects. Jonny Kapalo, the amateur paintball player, from West Kentucky had his eyes set on the joy of sh ooting in the mexcian home grounds of paintball, as one of the best ten places for paintballing.The game started at the crack of dawn when the teams split up. There were the Rottweilers and the meerkats. The players were to play in the paint-stained quagmire. The first game was ‘capture the flag’ and the meerkats (also known as Jonny’s team) had a good run since the game was theirs for the taking. The win was won by for his heroic dash for the flag which was quite a cheeky move, as his teammates distracted the adversary by covering for him. The second game was search and destroy, which consisted of four targets.The seekers of the game had a terminator of a man code name the ‘Predator’. The imprudent Jonny took the game as a joke and a couple of his teammates took into account of his plan of shooting the Predator. The error of this childish prank is that the Predator takes no hostiles even if it is caused by mutiny among his own teammates. At the coun t of three, with the predator in front of the scouting group, Jonny and his friends made their move, consequently, the more experienced player got the best of them and Jonny’s team was disqualified on the account of the uprising to the Predator.The third and final game was the team death match. This game has obvious objectives which are that you get terminated if you run out of paintballs or if you get shot. Each player was low on ammo and the last thing they wanted was to end the game. So each player had to examine their surroundings to look for places that could not be seen by the enemy. Jonny had thought of hiding behind a bush, to stalk his next victim. The unsuspecting detail of his hideout was unseen by the enemy.The next victim was to be his very own mother which was to be the most unlikely person to walk by. The poor woman was shot head to toe with suppressing shots. When she declared herself to be out of the game, Jonny crept back into hiding to wait for his next vic tim. But shortly afterwards the game was over and the Rottweilers won 2-1. We asked a few comments from Jonny and here is what he said, â€Å"The game was a game and I did not know that my mother would come out of cover and I would shoot her which was actually pretty awkward considering how well she could use a gun. Jonny’s mother had also shared her comments with us on how the game appealed to her. â€Å"The game was quite exciting, as an ex-marine I was born to be on the front line. The experience was a good one and it was great to see Jonny walking up my footsteps. † To me as a viewer the game was exhilarating and thrilling to watch, and informs me on the aspects of war and arts. This can stimulate a great experience which cannot be missed if one is able to afford. In my opinion Jonny’s mother forfeited the win to her son by exposing her cover.

Analytical Essay Sample on #8220;The Catcher in the Rye#8221; Holden’s Attitude to Life

Analytical Essay Sample on #8220;The Catcher in the Rye#8221; Holden’s Attitude to Life Holden’s attitude to life in general is a very confusing and indecisive one. His constant criticism and dislike for phonies joint with his strange ideas about life and the way in which it should be lived creates an image of a confused, uncorrupted and socially unstable youth of the time. He seems to think that he is the only person who can see, or who can be bothered to stop and see, that people are becoming mechanical in their following of the same old path of life that they know as the only way to live. He argues throughout the novel that these people are all fake and do not have any original ideas of their own. Throughout the novel Holden weaves a complex web of different feelings, attitudes and thoughts that can only be described as naively cynical. Holden’s attitude is negative towards all people who manage to enjoy the â€Å"phony† pleasures of life and live pleased that they have achieved the necessary. He feels this because he himself does not manage to fulfill the credentials needed to live this life both at school and outside. He does not contain any of the necessary qualities such as being an able sportsman, apt student or deadly womaniser. His attitude to society in general is a mixed one. He criticises everyone and not one person he writes of in the novel, other than his sister Phoebe, Allie and Jane, passes his approval. His attitude to society is actually quite realistic and normal for someone who takes the time to stop and see what’s actually happening. His views are consolidated from the experience he receives by living both the teenager at a respectable private school and the rich boy living almost on the streets. He experiences the dirty scheming mind of downtown New York as well as the uptown posh life of a well-raised prep school boy. He criticises everyone he meets on his pub-crawls around the New York bars and nightclubs. This is ironic in itself because he’s the young man with prospects drowning himself in his own misery and doing the best (unintentionally) to ruin his own life that could be perfect. Yet Holden knows that his life could be perfect but he is so persistent in not being the same as everyone else that he tries his hardest to ignore the opportunities for a perfect life given to him. His attitude towards women is a strange slightly old-fashioned one. He has the utmost respect for women and has difficulty acknowledging the maltreatment of them by other males. He tries to be friendly with most of the women he meets in the novel but often, as he always fears, he is rejected by them either on the account of his age or his strange behaviour. He attempts to get along with most of the males in the novel but finds it difficult at times as his super-critical assessment of people makes it difficult for him to get along with anyone. He befriends people that he feels sorry for such as Ackley, the pimply boy ostracized for being different. He does this because he can relate to him, as Holden knows well the feeling of rejection and loneliness. Holden’s mind is susceptible to change as whenever anyone makes him feel stupid, rejected or frustrated he immediately dismisses any good qualities he earlier graced them with. Everyone Holden talks about, other than Allie, Jane a nd Phoebe, has at least one flaw. In Holden’s eyes this makes them different to him, which translates to inferior at times. Whenever Holden is made to feel different, rejected or strange by anyone he becomes angry and frustrated. Holden feels strongly about certain identities that the people around him tend to assume. He indirectly creates an image of consumerism as an extremely negative part of the average American life, this is represented by his dislike of American status symbols (of prosperity) like the Cadillac, he believes that they should not represent a goal in ones life His ideas are not always right as he believes only what he wants and is not open to outside opinion and help. He generalises ideas about people; he says that people just want to take the easy and thoughtless option of following the ordinary cycle of life, he assumes that anyone who strives to own a Cadillac must be just another ordinary American with no original and thoughtful prospects in life.. It really displeases him when all people wish to achieve out of life are the material rewards, such as money, cars, houses and luxury goods. At times Holden makes it plain that he himself would like to enjoy this lifestyle and in some instanc es does. But I believe he only wants it because he knows he cannot achieve it and that really he feels no need to be the same as everyone else. This need grows from the way he has been made to feel that he is different in a bad way. He contradicts himself a few times in the novel but the main instance was when he wished everything to just stop and not become any worse that it was. His main reason for wanting the world to stop was driven by his protective feelings for his sister who he does not want to be corrupted by the evils in life. Holden really wants for her to retain the childish innocence that he loves so much. This wish for life to stop contradicts his beliefs that people should change the phony lives that they lead. Holden is an easy person to please. It seems Holden needs only small inexpensive things to please him. An example is the red hunting- cap he purchases when in New York. He buys the cap at a shop outside the station in New York directly after he loses all the fencing equipment on the subway. He does this because he believes even a small thing such as the hat can change him. It is a method of hiding from the humiliation or embarrassment he feels at any point in the novel. He uses it simply to hide when he gets into any situation he doesn’t like. This proves a weak point in Holden’s nature. He is actually very influenced by what people think of him and tries to hide when any negative views of him arise. This red hunting-cap manages to transport him from the mess of a life he leads to a different, better one. Another example of a significant item he owns is the mitt of his deceased brother Allie. This mitt that contains poems written by his little brother has a very signifi cant value to Holden. It is a sentimental item that Holden even uses as inspiration for an essay he writes for the ungrateful Stradlater. The mitt is very valuable to Holden as it contains all the memories of his much-loved brother Allie. Holden places only real importance to things that have sentimental value. While Holden insists that he places no importance on items of luxury he does seem to enjoy quite a luxurious life which in turn contradicts his basic beliefs. What Holden tries to prove to us in this novel is the importance of following ones own path of identity and being original. He, though, takes this to ridiculous lengths which remove all sense of sympathy we might have had for our protagonist, he is quick to speak, but much slower, he in fact ignores thinking when he can. From this we gather that thinking could prove fatal to Holden’s strong-hearted ideology.

Emission Spectrum Definition in Science

Emission Spectrum Definition in Science In general, an emission spectrum describes the wavelengths of the electromagnetic spectrum emitted by an energetic object. What this object is depends on the scientific discipline. In chemistry, an emission spectrum refers to the range of wavelengths emitted by an atom or compound stimulated by either heat or electric current. An emission spectrum is unique to each element. The emission spectrum of burning fuel or other molecules may also be used to example its composition. In astronomy, the emission spectrum generally refers to the spectrum of a star, nebula, or another body. How an Emission Spectrum Is Produced When an atom or molecule absorbs energy, electrons are bumped into a higher energy state. When the electron drops to a lower energy state, a photon is released equal to the energy between the two states. There are multiple energy states available to an electron, so there are many possible transitions, leading to the numerous wavelengths that comprise the emission spectrum. Because each element has a unique emission spectrum, the spectrum obtained from any hot or energetic body may be used to analyze its composition.

D. Question Assignment Example | Topics and Well Written Essays - 250 words

D. Question - Assignment Example The first step in determining any disease or nutritional deficiencies is to perform a physical examination which encompasses an assessment of age, sex, as well as anthropometric data (the measuring of weight, height, body mass index, and waist or arm circumference). According to Fischer & Hamilton (2013), the two primary techniques for carrying out a physical exam include body inspection and palpation. In addition, these two techniques are subdivided within themselves (p. 2). Shiny hair reveals healthy and nourished body, while an unhealthy body will show vulnerability to damage of hair or stop growing altogether, for example dandruff, baldness, folliculitis, pemphigus foliaceus, hirsutism, and grey hair (UMMC, 2013). While healthy nails will be smooth and strong, have a little color and be transparent, whereas unhealthy nails will have psoriasis, beau’s lines, onycholysis, yellow nail syndrome, and trachyonychia. Examples of nutritional deficiency diseases include scurvy, pernicious anemia, intellectual disability, rickets, kwashiorkor, marasmus, vitamin k deficiency, tetany, keshan disease, growth retardation, beriberi, pellagra, goiter, biotin deficiency, ariboflavinosis, hypocobalaminemia, night blindness, and paraesthesia (Mulcahy, 2012). Poor hair condition and diseased nails are triggered by chemical and hormonal imbalances, because of aging, illness and nutritional deficiency (Academy Medical, 2011). Furthermore, nutrition deficiency is a significant cause, resulting to chemical and hormonal imbalances, as well as illness, and accounts for the majority of both hair disorders as well as nail disease. Usually where there are nutritional deficiencies, it is due to improper working digestive system, an unbalanced diet, inadequate nutritional supplements and metabolism or inflammation within the body area where energy is being redirected. As a result, other

Digital media has changed the ways ideas, information, and arguments Essay

Digital media has changed the ways ideas, information, and arguments in society are communicated both locally and globally - Essay Example This revolution has changed the people’s lifestyles and actions are manipulated by the information that they can access. The availability of information due to digital technology has brought along positive and negative impacts on the new society referred to as the network society. This paper features out the various ways in which digital media has impacted on the society’s way of thinking and reasoning, and how this has changed their course of actions. In the Dark Age, an age where information was a scarce resource, the behavior of the people was so much influenced by their community traditions and social-cultural norms. Information was common only on the elite people and the society highly depended on such while working out their decisions. The elite community would misuse this privilege of having information to manipulate the reasoning of the people to make decisions that would favor their individual goals. This was common in the political arena where politicians woul d influence the voting process to suit their political ambitions during the campaign period. Deprived of the power of information the people were likely to arrive at immature conclusion and consequently uninformed decisions (Silverstone, 2005). The evolution of information technology has phased out this era and information can no longer be hoarded among the few elite in the society. Today, dense media networks are available and accessible to all humanity in the entire world, and its power cannot be ignored (Risi, 2013). The evolution of telecommunication devices and numerous service providers have brought about a whole new experience for the community with information from the global view available to the majority of the people. With television people can access live information, and with digital mobile phone communication takes place in real time across the boundaries. According to Silverstone (2005), the evolution of the digital technology has brought a new different morphology of the society, and the digital trends will have more influence on the society that it had ever been imagined. The proliferation of the internet has completely changed the world into a global village by closing in the distance that existed between different national boundaries. The emergence of video conferencing technology today people can communicate and hold conferences from their remote locations without any problem (Risi, 2013). The internet resource has become an answer for multinational corporations and international business can now be conducted at ease. The numerous social networks in the internet have formed new platforms where people can communicate, share and pass information, exchange ideas and influence the peoples thinking process, and hence their decision making practice (Silverstone, 2005). One of the areas where digital media have been used to influence the decision making process of individuals is in the political field. Today, political agendas can be propagated ac ross the world at a click of a mouse and it only takes few minutes before the entire world responds to an issue. This has had a great impact on the political campaigns since the factors of time, cost and distance have been put behind by the evolution of technology. On the other hand the people have vast information which they can use as a ground to make more informed and wise decisions. For instance, Cambodian politics general