Post Purchase Evaluation Process Free Essays

Post buy Evaluation Process Carlie Higdon MAN105 March 9, 2013 Professor Dana Adams Consumer post buy assessment is commonly influenced by pre buy desires, The buyer typically does a type of exploration to analyze costs and such before making a major buy, a house or a vehicle for instance. What's more, the assessment is whether they are upbeat or not with what they purchased. What is psychological disharmony (mental disunity) you may inquire? As per (businessdictionary. We will compose a custom article test on Post Purchase Evaluation Process or on the other hand any comparative point just for you Request Now com) intellectual cacophony implies State of mental pressure emerging from incongruence among a person’s perspectives, conduct, convictions, and additionally information, or when a decision must be made between similarly appealing or unpleasant other options. It comes down to one of those â€Å"Why did I purchase that for? † minutes. Regularly known as â€Å"Buyer’s regret. † Let’s see as an individual encounter of me having psychological disharmony. I get it would be the lance existing apart from everything else spur of the moment purchases. You know the stuff they put purchase the sales enrolls in stores. I wind up getting a great deal of that â€Å"As Seen On TV† things at Walmart. Last thing would need to be the â€Å"Bark Off. † Doesn’t work, the pooches just yapped at it. I discarded it. However, I resembled I could have utilized that cash for something better that I could have really utilized. Two items that can cause intellectual disharmony would be a house or a vehicle. In such a case that your not content with your buy that is two things that are difficult to reclaim and get your cash back. Presently by what method can advertisers and purchasers decrease psychological cacophony? Single word â€Å"COMMUNICATION. † Just by the marketers’ conversing with the open they can improve thought of what the buyer needs and needs. References http://www. businessdictionary. com/definition/intellectual discord. html#ixzz2NCPjUHpu The most effective method to refer to Post Purchase Evaluation Process, Essay models

Critical Care Sound Environments Health And Social Care Essay

Unique. Concentrated consideration units in hospitals take consideration of fundamentally wiped out patients under truly harrowing conditions. A turning writing is demoing that escalated consideration units ( ICUs ) are every now and again extremely loud and as often as possible rising above World Health Organization ( WHO ) guidelines1,2. Anyway few surveies have connected progressively expand investigations of the sound condition, for example, mean sound power per unit territory degrees, transient sound degrees, and ghastly dissemination, to nurture prosperity and open introduction. This review contrasts from old surveies in a few different ways. In particular, we have examined the conceivable effect of format plan applications on the highlights of ICU sound situations. This was cultivated by looking at the emotional and equitable characteristics of two ICU sound conditions with various format plans. Moreover, the overview notwithstanding: 1 ) point by point equitable and emotional clamor degree measurings at various areas in every one of the two units contemplated, and 2 ) examination of the relationship between the point and abstract commotion degrees by means of various factual preliminaries, including investigation of the effect of the ICU sound conditions on detected medical caretaker results.I. IntroductionThe sound situations of ICUs are aurally requesting while medical caretakers attempt to execute complex endeavors. It consequently is the fate of import to comprehend the satisfactory and unsatisfactory abstract and equitable characteristics of the ICU sound conditions from the attendants' place of position. In this overview, we accept attendants ‘ perceptual experience of their work environment sound condition is basic for the rating of undertaking and medical caretaker prosperity strong ICU sound situations. By coordinating the abstract perceptual experience measurings with equitable sound degree measurings, we can determine a progressively in tensive valuation for how physical and perceptual acoustic parametric amounts cooperate in the ICU scene. So as to cast obvious radiation on these worries, we concentrated on the undermentioned research requests in this relative research study: 1 ) Do equitable commotion degrees contrast: ( a ) between arranged areas inside a single basic consideration unit? ( B ) when looking at comparative areas in the two basic consideration units to one another? ( degree Celsius ) when looking at generally speaking ( mean ) degrees in the two basic consideration units to one another? ; 2 ) Do medical attendants' clamor initiated disturbance and uproar perceptual experience vary: ( a ) between arranged areas inside a single basic consideration unit? ( B ) when looking at comparative areas in the two basic consideration units to one another? ; 3 ) Does the detected effect of by and large commotion degrees in the work environment on abstract medical attendant prosperity and work open introduction v ary when contrasting two units with one another? ; 4 ) Is there a connection among point and emotional clamor degrees? ; 5 ) Is there a connection between commotion degrees and clamor initiated nurture results?II. Past RESEARCHA. Outline of Hospital Acousticss1. ResultsThe acoustic condition in hospitals can affect all inhabitants, including staff, patients, and visitants. The undermentioned treatment corresponding to the point of convergence of this study is to a great extent restricted with the impacts of commotion on staff individuals: accentuation and aggravation ; work open introduction ; health results and work over-burden. Data about how clinic acoustics may affect patients and visitants can be found in beginnings, for example, Bush-Vishniac et Al. 2 and Ryherd et al.3. The staff ‘s prosperity, proficiency and effectivity in introducing consideration and executing basic endeavors is basic to amplify understanding wellbeing, fulfillment, and consideration quality in ICUs . Stress-inconvenience: Intensive consideration unit are harrowing consideration scenes that can be exacerbated by the centripetal over-burden brought about by ecological components, including the acoustic condition. Stress is the individual ‘s appraisal of a crisscross between apparent interest and saw self-abilities to get by 4. Contingent upon the disagreeableness and duration, it might take to ailment ( for example , raised blood power per unit territory, dyspepsia ) , social modifications ( i.e, misery, despondency, negative mentalities ) . Tension is a mental reactions to natural incitements or action bring forthing awakening 5. Over the top tension degrees can take to upsets. Like nervousness, disturbance is one of the early mental reactions which mirrors the lack of desirability of nature upgrades 6. Bothering identifies with the attack of an incitement on a psychological or physical action. In one overview, higher mean sound power per unit zone degrees anticipated higher detected accentuation, and saw aggravation degrees in a Pediatric-ICU 7. In another study, less affectability to reverberate and more prominent character power (, for example, committedness, control, and challenge ) were connected with less clamor prompted accentuation 8. In a similar overview, ICUs attendants working eight-hour eventide removals detailed that they were altogether upset by clamor. There is a few grounds that high clamor degrees in consideration scenes add to staff accentuation and aggravation. Be that as it may, the figure of clamor initiated nurture accentuation surveies directed in the ICUs is truly constrained. Work open introduction: Hospital sound conditions that are strong of clinic endeavors might better staff effectivity in introducing consideration. Improved medical caretaker work open introduction in ICUs can prevent unpropitious occasions, better human services quality, and s treamline asset use. The review found that clamor in the working environment was seen to hold a negative effect on staff work open introduction and focus 3. A Neonatal-ICU review indicated that sound that surpasses 55dBA the greater part of the clasp can possibly meddle with work. This multidisciplinary writing reappraisal study featured that endeavors requiring fast response clasp and watchfulness are delicate to resonate. Commotion actuated work open introduction look into has been all the more typically directed in the working auditoriums 9-11. The effect of commotion on staff open introduction ( especially in ICUs ) has non been broadly inspected. Wellbeing results: The acoustic condition all through the hospital may loan to negative ague or ceaseless side effects in staff. Basic consideration nursing is a truly requesting occupation and it requires continuous watchfulness, watchfulness, and prosperity to carry on basic endeavors viably. The overview found that of the 47 ICU att endants reviewed in an ICU, revealed irritation, exhaustion and worries because of work environment commotion 3. The prior referenced overview other than indicated that expansion in mean sound degrees was fundamentally identified with an expansion in chest rate 7. Raised chest rate can connect to cardiovascular mischief especially in hypertensive people 12. Commotion instigated hearing misfortune has been the worry for executing sawboness in the working performance centers 13,14. Be that as it may, clamor incited health results ( including hearing misfortune ) of ICU medical attendants' have non yet been the point of convergence of clinic commotion writing. Work over-burden: Work over-burden can be basically of import for by and large prosperity of staff. Poor acoustical conditions in working environments can compound staff mentality and saw work over-burden. At the point when clamor degrees surpass a medical caretaker ‘s get bying capacities it can take to centripetal over-bu rden 6. Centripetal over-burden can do enthusiastic weariness, disappointment, and diminished feeling of individual accomplishment. This in curve can do sentiments of incapability, cumbersomeness, low fulfillment, and saw lack of achievement 15. In one study, it was discovered that medication botch and different unfavorable occasions important for tolerant security were related with passionate depletion and staff burnout 16. In another review it was other than discovered that nurture accentuation because of ICU commotion was emphatically identified with nurture passionate fatigue and burnout17. Hagerman et Al. demonstrated that in a coronary chest unit upgraded acoustical conditions, for example, diminished reverberation cut and improved location clarity improved staff disposition saw by patients 18. The constrained bing grounds focuses to a significant activity that ought to be examined more distant to discover suitable acoustic conditions that will limit negative work over-burden effects.2. Acoustic prosodiesThere is a turning natural structure of writing on clinic clamor. A considerable lot of those surveies center around qualifying generally speaking commotion degrees in a combination of emergency clinic infinites including ICU ‘s, however not many of them centers explicitly around ICU staff reaction 3. A combination of various techniques have been utilized in qualifying the clinic sound condition. The grounds of these methodological investigation contrasts are non acceptable realized 3 however might be identified with inspirations, for example, single inclinations, reasonableness, good judgment, comfort, the level of capable expertness, and so on ( 1 ) Overall commotion degree steps: These means have been favored most regularly. This might be founded on their common sense and comfort, in add-on to their joining into arranged rules, for example, WHO. Leq, Lmin, Lmax and Lpeak sound degrees can flexibly a general outline of the sound condition, yet th ey stay constrained for the detailed examination of the sound condition. ( a ) Leq: It empowers the rapid contrasting of the commotion degrees and suggested values and those in different sorts of infinites. Accordingly, it may be generally acknowledged as to be the essential advance to portray a sound situation. This may other than occur corresponding to the level of capable expertness required to give some infiltration about progressively expound highlights of the sound condition. In any case, this regular conviction can be misleading about reality and sufficiency of the use of essentially Leq degrees. ( B ) Lmax, Lpeak and Lmin: The most elevated and the least qualities estimated over clasp give more data about the over

Pushing Through Frustration Why Im Getting Rid of My Phone

Pushing Through Frustration Why Im Getting Rid of My Phone Whenever I make a big change in my life, I tend to get frustrated. When I got rid of television, the first few weeks were frustrating. When I killed the Internet at home, the first month was frustrating. When I stopped buying stuff for a year, the first four months were frustrating. When I changed my diet and started exercising daily, the first six months were frustrating. Eventually the frustration turns into reward, the pain becomes pleasure. This process is gradual, but it happens. The key for me has been finding ways to push through the initial frustrationâ€"pushing through the pain, knowing pleasure is just around the bend. In the end, tomorrows pleasure drastically outweighs the ephemeral pain of today. And now, for my next magic trick, Im getting rid of my smartphone for a couple months while I focus on rewriting my novel. In fact, Ill have no phone at all. No landline, no Skype, no cheap cellphone. Im not a Luddite. I dont think theres anything inherently wrong with TV, Internet at home, cellphones, or technology in general (all these things can be wonderful tools in our lives). Rather, I want to get rid of unnecessary distractions so I can be more productive, focus on whats most important, and better enjoy my life. More importantly, I want to see what effect this change will have on my psyche. Every change Ive made has had a profound effect on the way I see my lifeâ€"my perspective today is radically different from  yesterdays perspective. My lack of a telephone also means my face-to-face interactions with my friends will become more meaningful. Dinner or coffee or a walk through Dayton will mean so much more because we wont have the luxury of updating each other with every banal detail of our lives via text message or a five-minute phone call. Every interaction will be an opportunity for us to live in the moment, to be on the mountain. But what about emergencies? Truth be told, I cant possibly plan for every emergency. Its fear that makes us try to plan for every potential pothole. My neighbors have a phone if I really need one. My local coffee shop has Internet when I need to get online. My friends will still be able to contact me via email. Ill still be able to update social media when Im on the Internet. So many people have told me, I could never give up my cellphone. I used to say the same thing. The truth is, yes they could, but they choose not to live without. Theres nothing wrong with that choice, but realize you can do anything you want to do. Sometimes you just need to make the change and push through the initial frustration. Read about the results of this experiment: Reprogramming the Twitch.

Romeo and Juliet by William Shakespeare Essay - 566 Words

Are you the same person you were five years ago, or even yesterday? Most likely no, people change all the time they grow up and mature. If you have ever heard of the story of Romeo and Juliet you know it’s not the happiest of stories. As soon as Romeo and Juliet meet you can see that Juliet’s character shapes and develops more when she is around Romeo, but is this for the better, Did Juliet falling in love cause her to draw away from her family? Juliet is a sweet obedient young girl who has been taken care of by her nurse all her life. In the beginning of the play she only dreams of her future husband but in the end she is stabbing herself in the side while hovering over her dead husband. Juliet meets Romeo at the ball and his married to†¦show more content†¦If you have ever heard of the story of Romeo and Juliet you know it’s not the happiest of stories. As soon as Romeo and Juliet meet, you can see that Juliet’s character shapes and develops mor e when she is around Romeo, but is this for the better, Did Juliet’s falling in love cause her to draw away from her family? Juliet is a sweet, obedient young girl who has been taken care of by her nurse all her life. At the beginning of the play she only dreams of her future husband, but in the end she stabs herself in the side while hovering over her dead husband. Juliet meets Romeo at the ball and is married to him the very next day, even though the day before she wasn’t even interested in marriage. If Juliet hadn’t met Romeo she would have listened to her Dad and immediately married Paris, saying no to her Dad was a big change for Juliet. However is Juliet’s character change for the better? Juliet turned into a loyal, mature, faithful and sensible woman, but she also became very independent, strong willed, dishonest and disobedient. She had no problem defying her parents to marry their enemy, Romeo. If Juliet hadnt become so faithful she probably wouldn’t have taken her own life after finding Romeos Poisoned body lying next to her. Juliet was forced to mature way too quickly from an innocent teen to an adult. There were good changes and there were bad changes in Juliet’s behavior, all of Juliet’s good changes led to her own death.Show MoreRelatedRomeo and Juliet by William Shakespeare619 Words   |  3 PagesRomeo and Juliet by William Shakespeare is a play written in the 16th century that’s about a tragic love story between two teenagers who come from rival families, yet fate brings them together and despite the grudge that each family holds for the other; they fall in love. Throughout the story they hide their love from other people especially their families and marry and when Romeo is banished for murder they conceive a plan to run off together. From this story, we learn how two teenagers deceiveRead MoreRomeo and Juliet by William Shakespeare818 Words   |  3 PagesThroughout history, Shakespeare has been given credit for the popularizing of tragedies, causing a tragic hero to be seen as a reputable character. In Shakespeare ’s story â€Å"Romeo and Juliet,† two ill-fated lovers are caught between the bitter hatred of their two families. Knowing their parents would never approve, Romeo and Juliet struggle to keep their love a secret. Though the story ends in what most people would view as a tragedy, Romeo fails to meet the characteristics of a tragic hero establishedRead MoreRomeo And Juliet by William Shakespeare967 Words   |  4 PagesRomeo And Juliet by William Shakespeare In Romeo and Juliet the beauty and ardour of young love is seen by Shakespeare as the irradiating glory of sunlight and starlight in a dark work. Discuss the techniques that Shakespeare would have used to capture this dominating image of light. 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In the play Romeo and Juliet, by William Shakespeare, the playwright used the Nurse, Lord Capulet, and Friar Lawrence to show how taming the wills of the teens and forcing their wishes upon them could turn the play Romeo and Juliet into a tragic love story. The Nurse is one of the adults who is to blame for the tragic end of Romeo and Juliet.The Nurse is like Juliet’s mother and has a lot of trust towards the Nurse, but this changed when Juliet met Romeo. When Romeo and Juliet decided to getRead MoreWilliam Shakespeare s Romeo And Juliet1197 Words   |  5 Pagesforbidding it’s deadly, referring of course to the classic William Shakespeare play of â€Å"Romeo and Juliet†, set in Verona, Italy. The play examines two families, the Montauges and the Capulets caught in an ongoing battle of hate, however two of the children manage to find love. All is not fair in love and war, and this play examines some examples of how love and hate correlate to each other in this captivating tale of â€Å"Romeo and Juliet†. It’s a feud so deep and long lasting it seems that nothingRead MoreWilliam Shakespeare s Romeo And Juliet1287 Words   |  6 PagesLizzy Baginski English Composition 2 Mr. Spera March 10, 2015 Romeo and Juliet Research Paper The movie Romeo and Juliet is a modern classic film that took place in 1996. Overall this is a timeless story that everyone should go and watch. This movie has an intriguing plot line that tells the story of two feuding families, The Montagues and The Capulets, and how the children of these two different families fall in love. The two children overcome various obstacles such as hiding their chemistry fromRead MoreWilliam Shakespeare s Romeo And Juliet925 Words   |  4 Pagesmade by Romeo. This happens right after Romeo gets to Juliet’s grave, then meets Paris, fights Paris, and kills Paris.[a]Right before Paris dies, he says â€Å"Oh, I am slain! If thou be merciful, Open the tomb. Lay me with Juliet† (Shakespeare 5.3.72-73). Paris is brave and proud enough to tell Romeo, the person that kills him, to put him in the grave next to Juliet, who he was going to marry. Romeo’s true love for Juliet caused all of this in the first place. In the play, The Tragedy of Ro meo and JulietRead MoreWilliam Shakespeare s Romeo And Juliet967 Words   |  4 Pagesof ‘Romeo and Juliet’ written by William Shakespeare. Shakespearean time was between the middle Ages and the Industrial Revolution and it was branded by religious changes. William Shakespeare is widely known as the greatest dramatist of all time. Born April 1564, Shakespeare’s play ‘Romeo and Juliet’ is no doubt one of his most famous pieces. ‘Romeo and Juliet’ was first published in 1597 and its tragic story of banned love still captures the creativity of its audience today. ‘Romeo and Juliet’, althoughRead MoreWilliam Shakespeare s Romeo And Juliet 966 Words   |  4 Pages Beauty Over Gold â€Å"Beauty provoketh thieves sooner than gold.--William Shakespeare, 1623. In his book As You Like It, William Shakespeare pointed out the supremacy of love rather than the want of gold and wealth. Truly, beauty is more important to thieves than wealth. Many of the thieves in this world would rather have an elegant woman than to obtain precious rubies. After all, what good is a prosperous man if he doesn’t have a charming woman? Two famous men grab my attention who didn’t fear for

Asthma etiology Diagnosis and Treatment - Free Essay Example

Sample details Pages: 14 Words: 4127 Downloads: 7 Date added: 2019/08/08 Category Health Essay Level High school Tags: Asthma Essay Did you like this example? In order to better understand asthma, one must first go back to the basic fundamentals and etiology as well as pathophysiology of asthma in order to gain useful perspective. Asthma is one of the most common chronic conditions affecting both children and adults, yet much remains to be learned of its etiology. Asthma is a chronic, persistent inflammatory disease of the airways characterized by exacerbations of coughing, wheezing, chest tightness, and difficult breathing that are usually reversible, but that can be severe and sometimes fatal. Well controlled asthma consists of regular use of maintenance corticosteroids in order to reduce the number of exacerbations over time. Exacerbation of asthma is characterized by the worsening of symptoms with increase in dyspnoea, cough and wheeze. Many treatments are available to asthma patients yet the most popular is the use of corticosteroid therapy by way of inhalers. Don’t waste time! Our writers will create an original "Asthma etiology Diagnosis and Treatment" essay for you Create order This route is easy and simple and provides relief to the targeted area if administered correctly. Introducing inhalers to the newly diagnosed asthmatic, with proper training and compliance, can assist with the reduction of asthma exacerbations and the rate of severity. Using something as simple as a peak flow which will measure peak expiratory flow (PEF) can help the patient categorize themselves as having a non-severe or severe asthma exacerbation. Severe asthma exacerbations can be serious and if left untreated fatal. Patients have been found to have similar symptoms consisting of dyspnoea, unable to complete full sentences, increased heart rate and respiratory rate, wheezing and chest tightness, possible blue lips and agitation is also noted. If an asthma exacerbation is caught in the early stages administration of inhaled agonists consistently over the first hour, will show improvement and an increase in airflow. The pathophysiologic features of asthma can be broken down into three separate sections consisting of smooth muscle spasm, mucus plugging of the airways, inflammation of the airways, and biomarkers. The nervous system plays a large role in the control of the smooth muscle that is in the airways. The cholinergic system controls the smooth bronchial muscle while the beta-adrenergic system is consisting of a system of nerves in charge of the relaxing the smooth bronchial muscle. There is also the alpha-adrenergic system, which has fewer nerves in the airways, but still plays a role in the smooth bronchial muscle. All three systems must work together to provide a response that circulates the mediators that ultimately act as alpha-adrenergic receptors in the smooth muscle. Many theories have surfaced in reference to the difference between a non-asthmatic versus an asthmatic patients smooth muscle in the airways. One theory has stressed the possibility of a partial beta blockade, another a bnormal cholinergic mechanism, and a third theory has suggested a basic abnormality of the non-adrenergic inhibitory system. Airway inflammation is a common symptom of asthma and if not controlled quickly can lead to constriction. Assessing epithelial changes due to airway inflammation is important as the reaction caused by the inflammation is responsible for the damage therefore leading to a hyperreactive airway. Uncontrolled inflammation in the upper and lower airways and in the systemic circulation may compromise the control of allergic rhinitis and asthma, with subsequent disease progression. Mucus plugging can create respiratory distress for many a patient and research is still being conducted on whether or not findings of mucus plugging in asthmatic patients are more significant than that of the non-asthmatic patient. Researchers have used the study of an asthmatics sputum with plugs to further their knowledge in asthma etiology yet they cannot rely on this alone for diagnosing the severity of asthma. It is important to detect and monitor inflammatory occurrences by way of a variety of simple tests and procedures. There are many tried and true tests available in order to properly diagnosis asthma. Tests and procedures can include; blood panel, nasal wash, sputum sample, possibly an induced sputum, exhaled breath condensate and fractional exhaled nitric oxide. A large number of molecules measured in EBC, including LTB4, prostaglandin E2 and 8-isoprostane, are considered useful markers of airway inflammation and oxidative stress in the airways. µ Bonsignore et al. completed a study on pediatric patients in order to better understand the significance of biomarkers in induced sputum. Many biomarkers were found to be significantly higher in patients with moderate asthma versus healthy patients. These biomarkers include; interluekon-8 precursor (IL-8), matrix metalloproteinase (MMP-9), tissue inhibitor of metalloproteinase (TIMP)-1 and number of eosinophils. Fractional exhaled nitric oxide assessment was also completed as this is a reliable marker for airway inflammation. Mucus plugging can create respiratory distress for many a patient and research is still being conducted on whether or not findings of mucus plugging in asthmatic patients are more significant than that of the non-asthmatic patient. Researchers have used the study of an asthmatics sputum with plugs to further their knowledge in asthma etiology yet they cannot rely on this alone for diagnosing the severity of asthma. There are a multitude of causes of asthma and many of which start in childhood and can endure throughout a patients lifetime. Studies have found that genetics plays a large role in the predisposition for asthma. Some patients do not have a choice for the predisposition to have asthma as prenatal risk factors play a large role in the occurrence of asthma. Prenatal risk factors include prenatal smoking, diet and nutrition, stress, antibiotic use, mode of delivery. Risk factors can continue into childhood with many not by choice. Parents are encouraged to monitor transient wheezing, late or acute onset wheezing, and persistent wheezing as additional testing may need to be completed. Another risk factor is that of maternal diet restrictions which in turn can cause an allergy for the pediatric patient. Still a controversial subject, but the idea of not breastfeeding has been discussed and thought to deprive the infant of certain antibiotics which are necessary for future growth and deflec tion of disease. Decreased airway calibre in infancy has been reported as a risk factor for transient wheezing, perhaps related to prenatal and postnatal exposure to environmental tobacco smoke. Lastly, sex, gender, allergy sensitization, family structure, socio-economic status, reoccurring infections with use of antibiotics, exposure to smoke and animals are all considered significant risk factors that may make controlling childhood asthma a challenge. Many adults are diagnosed with asthma later on in life. This new onset asthma in adulthood could be caused by a series of occupational and environmental sources. Many occupations can have a number of chemicals and irritants in which repeated exposure can lead to airway inflammation. Many individuals start smoking, whether cigarettes or marijuana, in adulthood and for some the repeated exposure can cause airway inflammation. Some individuals have repeated respiratory sicknesses such as bronchitis, which when chronic, due to increased cough and sputum production can cause a rise in airway inflammation. Asthma is a manageable disease that is chronic with no cure but when properly treated and controlled exacerbations can be kept to a minimum. Asthma exacerbations can be traced back to two categories; viral infections and bacterial infections. Approximately 80% of exacerbations are associated with respiratory tract viral infections, with rhinoviral infection responsible for about two thirds of cases. ¶ Asthmatic patients may be more vulnerable to rhinovirus due to the lack of interferon productions. Interferons are antiviral proteins that play a role in fighting off viral infections. Asthmatics with an exacerbation with a viral component are mainly characterized by neutrophilic inflammation. Evidence of neutrophil degranulation and increased lactate dehydrogenase levels are independent predictors of severity, and increased levels of the potent neutrophil chemokine IL-8 are found in exacerbations. ¶ Researchers have mainly relied on viral infection components in order to better und erstand asthma but recognition and studies have been expanded to better understand the bacterial infection component and its relationship to asthma. Some studies have shown results that indicate that asthmatics are more likely to be affected by bacterial infections due to the increase risk of invasive pneumococcal disease. C pneumoniae, an atypical bacterium, has also been found to be significant yet more research needs to be conducted as results from current studies show bacterial components are secondary to viral infection. Diagnosis and Classification Classification of asthma is important as the different categories relate to the level of severity as well as recommended treatment. Classification starts with obtaining a detailed medical history as well as a detailed description of symptoms associated with asthma exacerbations. This medical history enables the physician to categorize the patient according to severity of symptoms. Patients are asked about their day and night symptoms, the frequency of asthma exacerbations and results from a lung function test can help categorize the patient as mild, moderate or severe in order for the physician to appropriate recommend the correct course of treatment. Physicians rely on many indicators and markers in order to clinical diagnosis asthma. Most asthmatics have chronic airway inflammation but the level of inflammation varies among patients and plays role in correctly diagnosing asthma. The most studied marker in exhaled breath is nitric oxide (NO). Elevated levels of fractional exhaled NO (FeNO) are found in both adults and children with asthma, as a consequence of up regulation of the enzyme iNOS. · Monitoring sputum cell counts was found to benefit patients with moderate-to-severe asthma by reducing the number of eosinophilic exacerbations and by reducing the severity of both eosinophilic and noneosinophilic exacerbations without increasing the total corticosteroid dose. Airway inflammation and hyperresponsiveness are used in characterizing asthma and research has been conducted in order to differentiate between the correlation of using inhaled corticosteroids and inflammatory cells in the airway. Crimi et al. researched and studied by using a methacholine challenge, with modifications for two study groups, bronchoalveolar lavage and biopsy, and eosinophil cationic protein assay in order better understand the relationship between airway inflammation and hyperresponsiveness. The study took a closer look at the airway lumen and mucosa and the relationship between inflammatory cells and hyperresponsiveness. Inhaled steroids caused a decrease of airway responsiveness that was paralleled by a decrease of eosinophils and other inflammatory cells in bronchial mucosa in only one uncontrolled study. Crimi et al. concluded, through their research, that a true perennial allergic asthmatics hyperresponsiveness is not directly related with the presence of eosinop hils, neutrophils, lymphocytes, or macrophages. Treatment of Asthma There is no known cure for asthma so early diagnosis and treatment will encourage maintenance and control with reduction in asthma exacerbations. A diagnosing physician will do a thorough physical exam as well as document a detailed medical history in order to correctly diagnosis a patient. Spirometry is also a helpful tool as it is a common medical office test used to assess how well the lungs work by measuring how much air is inhaled as well as how much air can be exhaled and how quickly. Spirometry is used to diagnosis asthma as well as several other respiratory diseases such as chronic obstructive pulmonary disease. Bateman et al. states, Asthma treatment for adults can be administered in different ways: inhaled, orally or parenterally (by subcutaneous, intramuscular or intravenous injection). The major advantage of inhaled therapy is that drugs are delivered directly into the airways, producing higher local concentrations with significantly lower risk of systemic side effects. ° Inhaled glucocorticosteroids, leukotriene modifiers, theophylline, omalizumab, systemic glucocorticosteroids, and short and long acting inhaled and oral B?‚‚ agonists are some of more popular treatments available for all age groups. For pediatric patients ease of administration is key. Inhalers have been the most popular route of administration of treatment as they are the easy to use as well as the fastest route for dispensing medication. Naturally each patient is different and customizing what works best for each individual is crucial in managing asthma. Patients with mild asthma or non-severe exacerbations can usually manage their asthma at home, or in the outpatient setting, utilizing fast acting inhaled B?‚‚ agonists in which using the rescue inhaler every twenty minutes for the first hour should produce positive results and relief in airway inflammation. Oral glucocorticoids can be used for mild exacerbations if the inhaler has seems to have no effect after one hour. Severe asthma exacerbations can be life threatening and knowing when hospital intervention is needed is key to survival. Urgent care centers have gained in popularity and if the mild asthma exacerbations require medical intervention, centers such as these might provide additional inhaled nebulizers, supplemental oxygen and a dose of steroids. This course of treatment usually can revise an asthma exacerbation but sometimes a higher level of care is needed in the emergency room. In the emergency room immediate intervention is needed in order to stop the pro gression of the exacerbation. Within the first hour emergency room staff may provide a higher level of oxygen, if needed, intravenous fluids to fight dehydration, a significantly higher dose of albuterol and ipratropium bromide nebulizer, and an aggressive dose of steroids. After the first hour a physician will reassess the patient and at that time significant improvement has been made or an additional round of treatment may be needed. Leukotrienes made of three separate molecules that, when together, create a powerful effect by stimulating smooth muscle contraction. Leukotrienes are known for their powerful bronchoconstrictor properties. Leukotrienes, in addition to other products in the 5-lipoxygenasse pathway, have been proven to be associated with asthma by way of the pathophysiologic responses they create. Drazen et al. explains the 5 lipoxygenase pathway as such; Leukotriene A?‚„ is unstable and is quickly converted to leukotriene C?‚„ or leukotriene B?‚„. In three cell types associated with asthma-eosinophils, mast cells, and alveolar macrophages-leukotriene A?‚„ is converted to leukotriene C?‚„ by the addition of glutathione at the C?‚†  position of leukotriene A?‚„, a reaction catalyzed by leukotriene C?‚„ synthase. Leukotriene C?‚„ is then exported to the extracellular space through a specific transm embrane transporter. In the extracellular space, the glutamic acid moiety is cleaved from leukotriene C?‚„ to form leukotriene D?‚„, which in turn is cleaved by extracellular dipeptidases to form the 6-cysteinyl analogue of leukotriene C?‚„, known as leukotriene E?‚„. Because leukotriene C?‚„, leukotriene D?‚„, and leukotriene E?‚„ all contain the amino acid cysteine, they are collectively referred to as cysteinyl leukotrienes. The cysteinyl leukotrienes are degraded rapidly in the extracellular space and the liver to inactive products. In neutrophils, leukotriene A?‚„ is converted to leukotriene B?‚„, which is a dihydroxy as opposed to a cysteinyl leukotriene, by the action of leukotriene A?‚„ epoxide hydrolase. Leukotriene B?‚„ is degraded by multiple pathways, including cytochrome P-450 (CYP4F4, CYP4F5) and 12-hydroxyeicosanoid dehydrogenase in multiple tissues. Cysteinyl leukotrienes are a subtype of the leukotriene receptor and mediate the tightening of pulmonary vascular smooth muscle. Leukotrienes have been proven to play a key role is asthma and the reaction to the airway as there is an increase in production during a reaction.Allergy induced asthma has an immediate reaction to the body as well as a delayed reaction of the leukotrienes. Regular use of leukotriene modifier and an antihistamine have been found to significantly reduce the allergic reaction as well as eliminate early indication of an allergen asthma attack. Chronic asthma can be determined by a pat ient having ongoing symptoms and a variance in the peak flow of 20% throughout a twenty-four-hour period. Many leukotriene modifiers are available to asthma patients. One such modifier was found to have a significant effect on leukotriene production. Zileuton inhibits leukotriene synthesis by inhibiting 5-lipoxygenase; clinical doses of zileuton reduce the synthesis of leukotrienes by 70 to 90 percent. Recently, the concentration of nitric oxide present in exhaled breath (FeNO) has been evaluated as a tool for assessing asthma. FeNO is elevated in patients with asthma, is reduced by treatment with inhaled corticosteroids, and correlates with eosinophilic airway inflammation measured using bronchial biopsies and induced sputum. Shaw et al. study researched the effectiveness of utilizing nitric oxide with standard asthma treatments versus no nitric oxide with treatment. There is a continuing discussion on whether or not FeNO is accurate in managing asthma. One research group completed a study that tested the theory that titrating corticosteroid dose using the concentration of FeNO results in fewer asthma exacerbations and more efficient use of corticosteroids, when compared with traditional management. Shaw et al. research indicated that there is no correlation between reduction in corticosteroid use and the reduction of exacerbation frequency. Though this study did find the particip ants ended the study on a lower dose of inhaled corticosteroids with no increase in exacerbations. With advances in technology throughout the medical field comes advancements in therapy for severe asthma. Omalizumab, a humanised anti-IgE monoclonal antibody specifically binding free IgE, has been introduced in asthma treatment. µ Omalizumab has been found to be very effective in reducing asthma exacerbations as well as reduce inflammation. Several other new drugs are on the market but additional research needed to be conducted as some have severe side effects. Nonpharmacological approaches, such as diet and exercise, have also become a trend in treatment recommendation in order to control asthma exacerbations. Asthma Disease Management Although pharmacologic intervention to treat established asthma is highly effective in controlling symptoms and improving quality of life, measures to prevent the development of asthma, including avoiding or reducing exposure to risk factors, should be implemented wherever possible. Asthma patients should participate in an allergy test as the results would assist with pinpointing certain allergens that could trigger asthma symptoms and exacerbations. Many patients seen in emergencies rooms during active asthma exacerbations have been found to have noted serum IgE antibodies in relation to common allergens. Chapman et al. states, Although an association between inhalant allergy and asthma has been recognized for over 50 years, in many cases it has been difficult to demonstrate cause and effect. This is because in part some asthmatic patients are nonallergic, and even in allergic patients many other factors are known to trigger asthma attacks, including viral infections, chemical exposure and nonspecific irritants. Likewise, patients are often not aware of a direct association between exposure to a specific allergen (dust mite) and the development of respiratory symptoms. As a result, the role of allergy is often hidden from the patient and many physicians regard allergic reactions as factors likely to exacerbate asthma, rather than a primary cause. Asthma self-management education encompasses a collaborative partnership between the clinician, the patient, and the patients caregiver. µ Education plays a key role in the patient having controlled asthma versus uncontrolled asthma. Utilizing something as simple as a peak flow will allow the patient to understand what the results mean and what the next step is if an asthma exacerbation is starting to happen. Myers et al., suggests, A written asthma action plan is the most appropriate method to provide concise instructions on managing ambulatory asthma symptoms and exacerbations. This written plan should include relevant information regarding triggers, medications, and emergency contacts. The patient should be familiar with and able to use a peak flow meter, and to know his or her personal best peak flow. When identifying triggers, it is important to consider the patients home life and what the child may be exposed to on a daily basis. Understanding what led to the most recent exac erbation can also help pinpoint what factors could be contributing. µ Education should also include a detailed written plan that the patient and others are aware of that explains the timeline for home treatment as well as when emergent intervention is needed by way of the emergency room. Continuing education has a direct relation with compliance amongst patients which ultimately has an impact on the global burden with healthcare costs in relation to asthma. Economic Cost of Asthma Considerable progress has been made in treating reversible airway disease, yet the prevalence and burden of asthma has increased in recent years. ¶ Smith et al. suggests, The appropriate use of maintenance medications and medical therapy allows many asthmatics to control their asthma, but the cost of treatment can be high. Treating acute attacks also consumes considerable medical resources. In addition, asthma symptoms often result in work and school absenteeism and lead to a decreased quality of life. ¶ Direct costs of asthma include diagnostic tests, prescribed medications, physician visits; which include office, clinic and emergency room visits, as well as inpatient hospital visits. The leading contributors to the direct medical cost of asthma in the United States are hospitalization costs and medication, representing approximately two thirds to three quarters of total direct costs. · Indirect costs are sometimes called opportunity costs and are the value of resources lost a s a result of time absent from work or other usual daily activity as a result of illness. · Loss of work, loss of school, days spent in bed and restricted or loss of physical activity are all areas that have a direct impact on the economic burden of asthma. Both direct and indirect costs have an influence on costs as outcomes and total costs. For example, a study looking at the impact of an asthma intervention based on peak flow monitoring found a reduced emergency department use among members of the intervention group, resulting in a significant cost savings. Global Burden of Asthma It is estimated that as many as 300 million people of all ages, and all ethnic backgrounds, suffer from asthma and the burden of this disease to governments, health care systems, families, and patients is increasing worldwide. Masoli et al. states, With the projected increase in the proportion of the worlds population that is urban from 45% to 59% in 2025, there is likely to be a marked increase in the number of asthmatics worldwide over the next two decades. It is estimated that there may be an additional 100 million persons with asthma by 2025. In order to better understand the global burden and costs of asthma one must understand the barriers worldwide. Genetics play a large role for the predisposition for asthma. Poverty and social class directly impact much of the population worldwide. Living situations and inaccessible medical assistance plague much of the third world countries. The inability to access proper medical care leaves many mothers unable to control the development of their children before birth. Even after birth, many factors still have a direct effect on a person with asthma. Air pollution, smoke, respiratory illnesses, such as tuberculosis, poor supply and cost of medication, as well as many more areas for concern, have a direct relation to the worldwide burden of asthma. Many factors have been identified as possible causes of the increased morbidity and mortality, including poor patient understanding of the disease process and of appropriate medication use, noncompliance with prescribed medical regimens, and an inability to use medications properly, especially inhalers. Evidence of morbidity from asthma was found in many patients taking little or no prophylactic medication and this should be amenable to improved education. ° Ultimately, reducing economic and worldwide mortality and morbidity all comes back to the basics. Correctly diagnosing and classifying asthma leads right into proper and continuing education as well as reinforcing with the individual the importance of utilizing the tools they have in order to live a more productive life with a reduced risk of mortality from asthma. Summary While asthma management and treatment have made huge strides over the past few decades, many questions remain regarding epidemiology, pathophysiology, environmental control, disparities in care, diagnosis, assessment, monitoring, pharmacology, exacerbation management, and education, and many great mysteries have yet to be solved. µ This papers purpose was to provide a definition and description of asthma and its etiology and pathophysiology in order to better understand diagnosing and classifying asthma correctly in the patient. The treatment and management of asthma continues to be a hot topic for discussion as the economic and global impact of asthma is significant and will only get more complex in the near future. There will be a need for collaboration and standardization in regards to care and treatment of asthma patients. Research that addresses asthma prevention, disease modification, and reversal of underlying mechanisms, is of particular need and importance. µ Improve acc essibility to essential drugs for the management of asthma in low? and middle?income countries. Adapt international asthma guidelines for developing countries to ensure they are practical and realistic in terms of different health care systems. Increasing the economic wealth and improving the distribution of resources between and within countries represent important priorities to enable better health care to be provided. Development of evidence-based interventions will also need to addressed in the future. Wider dissemination and implementation of evidence-based interventions that tailor care to individual risks and sensitivities, as well as to community-wide characteristics, must be investigated and deployed successfully across the continuum of care to ensure high standards of asthma care. µ Understanding asthma, its etiology and pathophysiology, can directly affect global costs by way of correctly diagnosing and classifying asthma patients, as well as promoting correct treatment and management through education and compliance.

Annotated Bibliography on Same-Sex Marriage

This annotated bibliography is meant to be an overview of my research towards a paper on same sex marriage. It evaluates four pieces of literature that I have chosen to use as external sources for my paper, providing a summary of the text and an argument for its relevancy: Case and Stewart’s (2009) study â€Å"Heterosexual Privilege Awareness, Prejudice, and Support of Gay Marriage Among Diversity Course Students,† Nussbaum’s (2010) article â€Å"A right to marry?†, Mills’ (2009) editorial â€Å"Its time to allow gay marriage in Australia,† and Australian Marriage Equality’s (2011) article â€Å"The Case for Marriage.† In my paper, I aim to use these sources to point out the logical fallacies in the arguments against gay marriage, as well as push for tolerance courses and diversity education as the key to addressing this systemic issue. Only then can the social attitudes regarding gays and lesbians ease up to the point where the case for marriage will no longer be so strongly opposed. The issue of same sex marriage is a very complex and difficult problem to solve; there is an entire minority group that wishes to be granted the same rights as heterosexuals, and is experiencing a great deal of resistance from those opposed to it. The arguments against homosexual marriage are as follows: it â€Å"ruins† the sanctity of traditional marriage, it flies in the face of normal, established society as people understand it, and people deem homosexual couples unfit for raising children. There are other arguments, but the majority of them seem, in my research, to be religion and values-based. My argument in this paper is that the decision whether or not to allow gays to be married is a rights-based issue, not values-based, and that people’s personal opinion on whether it is acceptable should not determine whether or not it is legal. The opposition to gay marriage stems from an overall social discomfort and intolerance of gays in general, and should not dictate le gislation. There is a systemic fear and lack of understanding of alternative lifestyles, and that leads to the prejudices that bring about gay marriage bans. Case, K., Stewart, B. (2009). Heterosexual Privilege Awareness, Prejudice, and Support of Gay Marriage Among Diversity Course Students.  College Teaching, 58(1), 3-7. Retrieved from EBSCOhost. In this study, Case and Stewart (2009) opted to evaluate the amount of homophobia and recognition of heterosexual privilege experienced by students in a diversity course throughout its run. Surveys were taken at the beginning and end of the course gauging the students’ sensitivity towards gays and lesbians, and they found that the participants grew more tolerant as a result of the diversity course. They became more aware of heterosexual privilege (namely, that their status as heterosexuals placed them at an advantage over homosexuals, as they had rights and social status that gays and lesbians do not), and even became more accepting of same-sex marriage. It also argues for the existence of sexuality-based diversity courses, instead of merely teaching about race and gender. This would improve education and raise acceptance of gays and lesbians and their right to marry. I would like to use this article as evidence that one way to create an environment that supports same-sex marriage is greater education and tolerance for minorities. The researchers were psychology professors at the University of Houston-Clear Lake, making them qualified to discuss attitudes and prejudices, and this study was published in 2010, making it a very recent case. NUSSBAUM, M. (2010). A right to marry?.  Dissent (00123846), 56(3), 43-55. Retrieved from EBSCOhost. In Nussbaum’s article, she makes the case that marriage in and of itself, much less same sex marriage, is difficult to define; there are many different marriages that do not include having children, or marriages that even occur without love. Therefore, it makes marriage very pluralistic and versatile. The point of this argument is that, because other marriages exist without some of the things that are normally associated with it, there is no reason to legalize a marriage between a same-sex couple, as it would have the exact same omissions of these aspects of marriage. Nussbaum (2010) even argues that the government should not be granted the right to allow marriages, much less deny them, as they are a governing institution, and should not have those rights. Nussbaum (2010) takes us through the history of marriage, and concludes that marriages even in the past were far less â€Å"traditional† than most opponents of gay marriage believe they are. Martha Nussbaum is a Professor of Law and Ethics at the University of Chicago, and the article is taken from her book, which was published in February 2010, making this a recent and reputable source. I will use this in my research to provide more factual arguments for marriage equality. Mills, R. (2009) Its time to allow gay marriage in Australia. The Punch. Retrieved March 23, 2011, from www.thepunch.com.au/articles/its-time-to-allow-gay-marriage. In this article, Mills (2009) argues the emotional points of view regarding his advocacy for gay marriage, mostly expressing incredulity that it has not happened yet. The facts and ideas presented within it are, for the most part, based on opinion, as it is an editorial piece. It expresses Mills’ (2009) opinion on same sex marriage, with a few statistics peppered in (50% of marriages ending in divorce, 60% of other Australians supporting same-sex marriage). Mills (2009) is an actor and musician, not a writer, and he bases his opinion on the subject on the experiences he has had with gay friends and relatives. As the subject of gay marriage is an emotional issue, it is important to include the more sympathetic, emotion-based appeals for its legalization. This article was written in 2009, so it is fairly recent, though it may not reflect the most current changes in gay marriage legislation. However, it merely provides an emotional opinion by its author in order to address the normal, reactionary arguments against gay marriage, such as religion-based opposition and claims that it damages traditional families. Mills also posits that gay couples should also be allowed to adopt kids, as there are plenty of loving families that would love to have children. The Case for Marriage. (2011) Australian Marriage Equality Working for equal rights for all   Australians. Retrieved March 23, 2011, from http://www.australianmarriageequality.com/case.htm This article provides a more logical, sensible explanation for why same-sex marriage should be legalized. It explains how the couples would be advantaged as a result, namely allowing them to express their love for each other in the same way that heterosexuals do. It repeats the arguments that, regardless of personal opinion regarding gay marriage, it is not something that should be made illegal, as it is a basic human right. Currently, federal law states that it â€Å"is acceptable to exclude lesbian, gay, bisexual and transgendered persons from a central social institution, and that [their] relationships are inferior.† (2011) The primary case is that â€Å"no group of Australians should be systematically excluded from any legal institution,† which includes marriage. The author of this article is not listed specifically, but it is a piece of literature from the organization Australian Marriage Equality; therefore, it does work toward that agenda. Again, it is an opinion piece, but it provides logical arguments for allowing gay marriage (presenting it as a case of discrimination, as a group of people are being denied rights). It is important to understand the basic logical arguments in favor of gay marriage in order to grasp the aim of the research of this paper. CONCLUSION In summary, these three articles (and one study) will help to support my case that gays and lesbians should be granted the right to marry. Two of them provide emotional and logic based arguments for gay marriage, making impassioned pleas to those who oppose them to change their minds and see the error of their ways. One of those is an editorial from an average citizen, the other a piece of press from a gay rights advocacy group. A third article goes through the history of marriage itself, for the purposes of debunking the myth that marriage has always been a certain way, and that it should not be changed. It also explains the arguments against gay marriage, and why they are not sufficient to warrant a lack of legalization. Finally, there is a study that indicates that acceptance of same-sex marriage would be greater if people were educated in sensitivity toward minorities, and given a properly informed perspective towards homosexuals. This would allow them to allay their fears about homosexuals, and grant themselves a greater understanding of equality among individuals. All of my research sources are recent and relevant, as well as reputable. I believe they would have a great deal of use in my paper towards explaining the aforementioned points. The road to same sex legal marriages is a long one, and there is a great deal of opposition from many sides towards it. The only way to secure the rights for this group of people is to inform them of the flaws in their case for banning gay marriage, and showing them that allowing gays and lesbians to have rights is not something that will â€Å"ruin† marriage for the rest of the population.

The Colonization Of The Ottoman Empire After World War I

The colonization of Muslim territories began with the rise of European empires, the conquest of India, the scramble for Africa, and its last phase included the division of the Arab territories of the Ottoman Empire after World War I. An economic system began to take shape in the later 17th century but fully matured in the 19th century, once the European powers had established economic and political predominance around the world through the establishment of colonies and the exercise of aggressive imperialistic strategies. One method was through trading companies that were given the right to arm and use military force to protect their economic interest as if they were governmental agencies, even thought they were private, joint-stock companies. The core markets (Europeans) control the means of production and distribution of goods, and they also control the labor pools that produce the goods, while the periphery (Middle Easterners) supplies the core with raw materials and labor at price s determined by the core. As economic practices of the Europeans merged into Middle Eastern society, so did their culture and political practices. Muslim populations that had previously identified themselves as distinct, based on their cultural, ethnic, and/or religious heritage, were forced to unify under a single national identity by the Europeans. Certain Muslim populations were denied their political, economic, social, and human rights. 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