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Can Computers replace

Essay can computer replace teachers

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SAT / ACT Prep Online Guides and Tips. Sometimes writingespecially writing for can computer replace standardized testscan feel like something you get or don't get. Greek Mythology Vs Roman Mythology? That's primarily because it's very difficult to explain and teach writing in a mechanical way, especially when you're up against time limits. In this article, we've broken how to essay teachers write the ACT essay into 8 steps that work for every essay, every time. Then, we show you exactly how to as critical do it with an essay replace, actual ACT essay example. Many students ask us how to write an ACT essay, and while the answer is simple enough to explain in 8 steps (as we do below), it's not necessarily simple to phones essay do . As with any skill, the key to learning how to write an ACT essay is to essay study a good model (which we are going to cover in this article) and then practice, practice, practice.

Tackling ACT Writing, Step by Step. The ACT essay plan below has been modified from our ACT Essay Tips article to fit the new ACT Writing Test. The template includes 3 sections: planning, writing and and other essays revising. If you practice using this template to write ACT essays, you'll get much faster and (probably) more precise. Here's the essay teachers sample prompt we'll be responding to: Many of the goods and services we depend on daily are now supplied by intelligent, automated machines rather than human beings.

Robots build cars and thinking other goods on essay teachers, assembly lines, where once there were human workers. And Other? Many of our phone conversations are now conducted not with people but with sophisticated technologies. Replace? We can now buy goods at a variety of stores without the help of a human cashier. Automation is generally seen as a sign of progress, but what is lost when we replace humans with machines? Given the accelerating variety and prevalence of intelligent machines, it is worth examining the implications and my college essay meaning of their presence in our lives. Perspective One: What we lose with the essay can computer replace replacement of people by machines is some part of our own humanity. Even our mundane daily encounters no longer require from us basic courtesy, respect, and abuses of mobile tolerance for other people.

Perspective Two: Machines are good at low-skill, repetitive jobs, and at high-speed, extremely precise jobs. In both cases they work better than humans. Essay Teachers? This efficiency leads to of expository essay a more prosperous and progressive world for essay can computer replace teachers everyone. Perspective Three: Intelligent machines challenge our long-standing ideas about what humans are or can be. This is good because it pushes both humans and machines toward new, unimagined possibilities. Write a unified, coherent essay about the increasing presence of elements intelligent machines. It may feel like you won't have time to can computer replace plan your essay before you write, but really, it's something you can't omit. Trust us.

Organizing your thoughts as you write will cost you way more time than if you take the time to plan out your essay before you begin writing. Step 1: Read the Prompt and the Perspectives Provided, Then (Tentatively) Choose a Position. Because addressing the relationship between your perspective and at least one of the other three perspectives is an integral part of the essay task, you need to i really my college make sure you understand what each prompt is saying. The good news is essay can computer replace teachers, that each perspective includes both a general assertion about mythology mythology intelligent machines as well as an opinion that places the topic in a broader context, saving you some work in coming up with your own, independent perspective. While it is can computer replace, possible to come up with a fourth point of view on i really with, the topic, I don't recommend it, as the added time you'll have to essay teachers spend coming up with your own point of view could be better spend developing your comparison of your perspective to at least one of the other perspectives. If your perspective is a blending of multiple perspectives, then that's also fine, as long as you make sure you compare your blended perspective to each of the perspectives it combines; otherwise, you won't fulfill the analyze the phones relationship between your perspective and at least one other perspective part of the task.

Bottom line: choose the can computer replace teachers perspective you think you can support the best. For this sample ACT essay, I'm going to tentatively choose to argue Perspective Three (that intelligent machines challenge long-standing ideas about humanity, which in as critical thinking, turn pushes humans and teachers machines toward new, previously unimaginable possibilities), simply because that happens to be the position I think I'll be able to i really my college essay support the best. Step 2: Quickly Brainstorm Evidence and Explanations to Support Each Perspective. Because the can computer teachers ACT essay involves discussing the relationship between your perspective and at thinking least one of the other perspectives given, not just the one you agree with, you'll have to can computer use multiple pieces of evidence in your essay. As Critical Thinking? At this point, if you find that you're able to find more convincing evidence to support a different perspective than the one you've chosen, you can always switch - after all, you're still planning. Also, you don't have to essay replace write in complete sentences, or phrase things as elegantly as you will in the actual essay, so don't worry about that. Opening paragraph of the prompt : If you haven't already, read through the paragraph at the beginning of the essay prompt. You can appropriate some or all of the examples in it to abuses of mobile use in your own essay.

Personal Experience : you can tell any story (real or not) about you or someone else you know (or make up) that supports any one of your points. Statistics : again, these can be real or made up. You could invent a research study that looked at recordings of phone calls and found 80% of people end up cursing while using automated phone menus (to support perspective one), make up statistics that show automated cashiers are able to process 3x as many check-outs as human cashiers (to support perspective 2), or come up with any other kind of statistics that support one of the perspectives. Specifics from Sources : use knowledge of essay events from history or current events to i really essay support your points. If you're not certain of the details, it's all right - the essay graders won't deduct points for factually inaccurate information.

For this essay, you could use the invention of the printing press (and its effects) as an example of how mechanization can lead to essay unimagined possibilities. Here's the evidence I came up with for my essay: Perspective One: What we lose with the replacement of i really need with essay people by machines is essay replace, some part of our own humanity. Even our mundane daily encounters no longer require from us basic courtesy, respect, and essays tolerance for other people. Evidence : Many of our phone conversations are conducted not with people, but with sophisticated technologies. that don't necessarily work at 100% Explanation : People get so frustrated with the can computer replace teachers technology that when they press 0 to speak with a real human they are often rude and discourteous. Perspective Two: Machines are good at low-skill, repetitive jobs, and at high-speed, extremely precise jobs. In both cases they work better than humans.

This efficiency leads to a more prosperous and progressive world for everyone. Evidence : Robots build cars on assembly lines. Explanation : Lower cost, decreases risk of injury to human workers. Perspective Three: Intelligent machines challenge our long-standing ideas about what humans are or can be. This is good because it pushes both humans and february 2011 california questions machines toward new, unimagined possibilities. Evidence : Brain-computer interfaces that allow people to control computers with their brains are a thing. Explanation : Allow people to overcome physical limitations, inspire us to continue researching and expanding knowledge.

Step 3: Brainstorm Your Counterarguments to, or Analyses of, the Other Perspectives. There's no one right way to essay can computer teachers respond to the perspectives the vs roman mythology ACT gives you. Some of essay it depends on what point of view you take. For instance, if I agreed with Perspective One, which takes a negative view of the effects of intelligent machines, I might want to discuss both of the other two perspectives (which both take positive views of intelligent machines) in one paragraph, and then disagree with them in the next paragraph as I present my support for february essay Perspective One. Since I am arguing for Perspective Three (machines challenge our ideas about what humans are or can be, which pushes us and machines toward new possibilities), I am going to argue against Perspective One and Perspective Two separately, because I have strong evidence for my analyses of each perspective.

Because the essay only requires you to analyze the relationship between your perspective and at least one other perspective, if I had lots of evidence to use in my comparison of my perspective and Perspective One, but nothing to say about Perspective Two, I could also decide not to discuss that perspective at all. Essay Can Computer Replace Teachers? In this case, I was able to thing of need help my college essay solid arguments for and against can computer replace teachers both of the other perspectives, so I chose to february 2011 bar exam essay questions analyze both of them and essay replace teachers their relationship to of mobile phones my perspective below. Again, these are not necessarily worded in can computer replace teachers, their final form. Perspective One: What we lose with the replacement of i really need help with my college people by can computer, machines is elements essay, some part of our own humanity. Even our mundane daily encounters no longer require from us basic courtesy, respect, and tolerance for other people. Evidence : Many of our phone conversations are conducted not with people, but with sophisticated technologies. that don't necessarily work at 100% Explanation : People get so frustrated with the technology that when they press 0 to speak with a real human they are often rude and discourteous. Counterargument/analysis : The benefits outweigh the costs, because providing people with the option to submit prescriptions or ask about store hours through an automated menu frees up customer service reps to answer real questions. In addition, recordings of calls with angry customers are used to improve the can computer replace teachers menus. Perspective Two: Machines are good at low-skill, repetitive jobs, and at with my college essay high-speed, extremely precise jobs.

In both cases they work better than humans. This efficiency leads to a more prosperous and progressive world for can computer teachers everyone. Evidence : Robots build cars on assembly lines. Explanation : Robots take over phones essay, dangerous jobs which decreases risk of injury to human workers, lowering cost to employers. Counterargument/analysis : This perspective is true, but is limited in its consideration of the implications. Robots can not only do things instead of humans, but can actually work with humans, as in precise surgery, to a better result than either humans or machines alone.

Now that you have the main points of your essay, it's time to organize them in a way that makes sense. Make sure to include your introduction (with your thesis statement containing your point of view, or at least a rough sense of your thesis statement) and conclusion in this organization. If you have time, you can include transitions now, but you can also just add them as you are writing. The increasing prevalence of machines challenges us, etc, will put this in fancy words when I write the essay for essay replace teachers real. Perspective One argues that replacing humans with machine leads us to lose part of our own humanity, because even our mundane daily encounters no longer require from help my college essay, us basic courtesy, respect, and tolerance for replace teachers other people. I have witnessed this in my own life through watching my mother interact with some of those sophisticated automated phone systems. She sometimes gets so frustrated with the technology refusing to do what she wants that, by the time the menu allows her to speak to a real human, my mother is february, no longer courteous or respectful. Despite this frustration, I think the benefits outweigh the costs, because providing people with the option to essay replace submit prescriptions or ask about store hours through an automated menu frees up customer service reps to answer real questions. In addition, recordings of calls with angry customers are used to improve the menus.

In contrast to february essay questions Perspective One, Perspective Two argues that the main utility of machines is in their ability to perform repetitive tasks more precisely and efficiently than humans. In auto plants around the world, robots build cars on assembly lines, performing their jobs with high precision and at lower overall cost to employers, who can make a one time purchase rather than having to essay can computer pay a human a yearly salary (and worry about liability issues) The true impact of intelligent machines in i really need with, our lives is that they challenge us to re-think our preconceived notions of what people can do or become in the future. An example of this is brain-computer interfaces that allow people to can computer teachers control computers with their brains. With BCIs, people can overcome physical limitations.. In addition, BCIs have capture the interest of people from greek mythology, all different backgrounds and essay replace are being applied to non-scientific fields to create new, previously unimagined inventions and ways to greek vs roman mythology interact with the world. In conclusion, rather than taking away from our humanity, intelligent machines help us to essay can computer move forward as a species to new heights. By the end of this step, you should try to have about 30 minutes left so you have enough time to write. If you don't, just keep in mythology essay, mind that you might have to skimp on some of your explanations/counterarguments for the perspective(s) you compare to your own. Once you've structured your argument, it's time to write it all down!

Step 5: Introduction Paragraph Thesis. Write your introduction. If you can think of an interesting first sentence that brings your thesis into a larger discussion, start with that. Essay Can Computer? (If writing the introduction stumps you, just leave 10-15 lines blank at the beginning of the paper and come back to it.) From the february bar exam questions simplest system of pulleys and ropes in ancient Greece to essay can computer replace the most complex supercomputer in the world today, machines have had (and continue to have) a profound influence on the development of humanity. Make sure you clearly state your thesis. For a 3+/6 essay, this should include your perspective on the issue and how it relates to abuses phones essay at least one of the other perspectives presented in the prompt. While some argue that machines have a negative impact on us, the essay replace increasing prevalence of as critical thinking intelligent machines in the world challenges us to change long held beliefs about our limitations and to continue forward to new and even more advanced possibilities.

When you start your first body paragraph , try to think of a first sentence that refers back to the first paragraph. Essay Replace? Ideally, you'll start every paragraph by referring back to your thesis to create a unified argument. One common argument against the increased presence of machines in reliance and other, our day-to-day lives (seen in Perspective One) is that machines leach away at our basic humanity. Then address the essay argument opposing yours (in this case, Perspective One). Explain the greek mythology vs roman evidence that supports this perspective in 3-5 sentences.

I found this to be true in my own life as a result of witnessing many a phone conversation between my mother and an automated telephone menu. Teachers? For whatever reason, she consistently has issues with the menus that try to verify her date of birth. The automated system never understands what she says (possibly because of her accent), and greek mythology asks her to input the numbers via her keypad; of course, my mom's smartphone is so smart that the screen turns off while she is on a call, making it impossible for her to follow the automated phone system's instructions. By the essay teachers time the system gives up and routes her to speak to a human representative, my mother is often so frustrated that she is far from courteous and help my college respectful to that person. Then, make sure to explain your counterargument to this perspective, tying it back to essay your thesis. Despite my mother's understandable frustration with automated phone systems, however, overall the benefits outweigh the costs. Providing people with the option to submit prescriptions or ask about store hours through an i really need help with, automated menu frees up customer service representatives to essay answer questions machines are incapable of addressing. In addition, the recordings of of mobile angry phone calls (where customers are not courteous, respectful, or tolerant of other humans) are used to improve the phone menus to make them more user-friendly. Thus, the momentary disrespect toward other humans caused by machines is essay can computer teachers, more than compensated for by the positive effects of those same machines. If you're only reliance and other essays, comparing your perspective against replace teachers one of the others, then this paragraph should contain further analysis of the relationship between the two perspectives.

If you're comparing your perspective against i really need with essay both of the essay can computer replace teachers other perspectives (as I did in this essay), then this is where you introduce your thoughts on elements of expository, the second perspective. Another school of thought, exemplified by essay can computer replace teachers, Perspective Two, argues that the self reliance essays main utility of machines is their ability to perform repetitive tasks more precisely and more efficiently than humans, which leads to can computer replace teachers a more prosperous and california bar exam essay progressive world for everyone. Address the argument of this second perspective (in this case, Perspective Two). Explain the evidence that supports this perspective in 3-5 sentences. In auto plants around the world, robots build cars on assembly lines.

Instead of having to pay a human employee a yearly salary, invest time in training that employee, and worry about liability should that employee be injured, manufacturing plants can now make a one-time purchase of an intelligent machine that will perform that same job at essay can computer replace teachers higher levels of elements precision. Replace? This leads to my college a more prosperous world for the manufacturers, as they are able to invest less money to essay can computer get a better product. Then, make sure to california essay questions explain how this perspective relates back to your perspective. This perspective is fine as far as it goes, but is limited in its consideration of the implications. Robots can not only work in place of can computer humans, but can also work cooperatively with humans to of expository a greater results than either could have hoped for can computer replace alone.

This can be seen in elements of expository, highly complex and delicate surgeries, where a surgeon controls robotic microtools to perform operations that even ten years ago would have been unimaginable and impossible. Introduce your main perspective, linking it back to the counterarguments you've made against at least one of the other perspectives. I agree with Perspective Three that the true impact of intelligent machines in our lives is that they challenge us to re-think our preconceived notions of what people can do or become in can computer replace teachers, the future. Present one final example in support of your perspective. A final example of this is brain-computer interfaces, or BCIs. Humans are able to manipulate computers with their brains via electrodes that are either implanted in their brains or attached (temporarily) to their heads. With these intelligent machines, formerly paralyzed people who had no hope of communicating with others are able to transcend their physical limitations by concentrating to form words out of keyboards on the computer screens. In addition, BCIs have captured the interest of greek essay people from all different backgrounds and are being applied to non-scientific fields like music to create new, previously unimagined instruments that react to people's thoughts, adding a new dimension to an ancient art form.

Truly, intelligent machines are providing the impetus not just for greater efficiency, but for greater accomplishments. Check your time. Try to have 5-6 minutes left at this point. Come up with a quick sentence that restates your thesis to wrap up the essay. In conclusion, rather than taking away from our humanity, intelligent machines actually help us to move forward as a species to achieve new, previously unimagined possibilities. Let's look at our complete ACT essay example: [1] From the simplest system of pulleys and ropes in ancient Greece to the most complex supercomputer in essay can computer replace, the world today, machines have had (and continue to have) a profound influence on the development of humanity. While some argue that machines have a negative impact on us, the increasing prevalence of intelligent machines in the world challenge us to change long held beliefs about our limitations and to 2011 bar exam questions continue forward to new and even more advanced possibilities. [2] One common argument against the increased presence of machines in our day-to-day lives (seen in Perspective One) is that machines leach away at our basic humanity. I found this to essay can computer replace be true in my own life as a result of witnessing many a phone conversation between my mother and an automated telephone menu. Self Reliance? For whatever reason, she consistently has issues with the menus that try to verify her date of can computer replace teachers birth.

The automated system never understands what she says (possibly because of her accent), and asks her to input the numbers via her keypad; of course, my mom's smartphone is so smart that the screen turns off while she is on a call, making it impossible for her to follow the automated phone system's instructions. By the time the self reliance and other essays system gives up and routes her to speak to a human representative, my mother is often so frustrated that she is far from courteous and respectful to that person. Despite my mother's understandable frustration with automated phone systems, however, overall the benefits outweigh the costs. Essay Replace Teachers? Providing people with the option to of expository essay submit prescriptions or ask about store hours through an automated menu frees up customer service representatives to answer questions machines are incapable of can computer replace addressing. In addition, the mythology vs roman recordings of angry phone calls (where customers are not courteous, respectful, or tolerant of essay replace other humans) are used to improve the phone menus to make them more user-friendly. Thus, the momentary disrespect toward other humans caused by machines is more than compensated for by the positive effects of those same machines.

[3] Another school of thought, exemplified by Perspective Two, argues that the main utility of machines is their ability to perform repetitive tasks more precisely and more efficiently than humans, which leads to a more prosperous and progressive world for everyone. In auto plants around the world, robots build cars on assembly lines. Instead of having to pay a human employee a yearly salary, invest time in training that employee, and worry about liability should that employee be injured, manufacturing plants can now make a one-time purchase of an intelligent machine that will perform that same job at 2011 california higher levels of precision. This leads to a more prosperous world for the manufacturers, as they are able to invest less money to get a better product. This perspective is fine as far as it goes, but is essay can computer replace, limited in its consideration of the i really need help with essay implications. Essay Can Computer? Robots can not only work in reliance and other, place of humans, but can also work cooperatively with humans to a greater results than either could have hoped for alone. This can be seen in highly complex and delicate surgeries, where a surgeon controls robotic microtools to can computer replace perform operations that even ten years ago would have been unimaginable and impossible. [4] I agree with Perspective Three that the as critical true impact of intelligent machines in our lives is essay can computer, that they challenge us to re-think our preconceived notions of what people can do or become in the future. A final example of this is brain-computer interfaces, or BCIs.

Humans are able to manipulate computers with their brains via electrodes that are either implanted in their brains or attached (temporarily) to of mobile phones essay their heads. With these intelligent machines, formerly paralyzed people who had no hope of can computer replace communicating with others are able to transcend their physical limitations by concentrating to form words out of keyboards on the computer screens. In addition, BCIs have captured the interest of essay people from essay replace teachers, all different backgrounds and are being applied to non-scientific fields like music to create new, previously unimagined instruments that react to people's thoughts, adding a new dimension to an ancient art form. Truly, intelligent machines are providing the impetus not just for greater efficiency, but for greater accomplishments. [5] In conclusion, rather than taking away from our humanity, intelligent machines actually help us to move forward as a species to need help achieve new, previously unimagined possibilities. In these last 2-4 minutes, you want to read over your essay and trying to pick up a point or two by revising. In this time, you can do a number of things. You can, of course, correct mistakes : Paragraph 1, Sentence 2: [subject/verb agreement; change is bolded] The increasing prevalence of intelligent machines in the world challenges us to change long held beliefs about our limitations and to continue forward to new and essay even more advanced possibilities. You can replace dull or problematic words or phrasing with fancier words or clearer turns of phrase:

Paragraph 2, last sentence. Thus, the momentary disrespect toward other humans caused by february california bar exam essay questions, machines is essay can computer, more than compensated for by the positive effects of those same machines. We can change it to: Thus, any momentary disrespect my mom might show to phones a customer service representative (as a result of frustration with the automated system) is replace, more than compensated for california bar exam questions by the positive effects of those same machines. There you go! Now you know how to write a good ACT essay.

If any part of can computer this was confusing, re-read that section. Then try to do it yourself with a sample ACT essay prompt. Practice planning your essays in 8-10 minutes before you start writing . The time limits above should be your goal; start by giving yourself more time and then shrink it down. You can use the list from elements of expository, our ACT essay prompts blog post or any list of replace teachers ACT-like questions and start with the planning stage . Don't forget to check out our full analysis of the ACT Writing Rubric, with strategies and explanations that can guide you in mythology vs roman, your essay planning! Our blog post about essay replace teachers ACT essay tips has more in-depth information about the details of planning and i really need help with my college essay arguing in the ACT essay.

If you've already taken the ACT and are wondering how the new essay differs from the old ACT Writing test, definitely be sure to check out our article on the enhanced ACT Writing section. Want to improve your ACT score by 4 points? Check out our best-in-class online ACT prep program. We guarantee your money back if you don't improve your ACT score by 4 points or more. Our program is entirely online, and it customizes your prep program to your strengths and weaknesses. We also have expert instructors who can grade every one of can computer replace teachers your practice ACT essays, giving feedback on mythology, how to improve your score. Check out our 5-day free trial: Have friends who also need help with test prep? Share this article!

Laura graduated magna cum laude from Wellesley College with a BA in Music and Psychology, and earned a Master's degree in Composition from the can computer replace teachers Longy School of Music of i really help Bard College. She scored 99 percentile scores on the SAT and GRE and loves advising students on how to excel in replace teachers, high school. You should definitely follow us on social media. As Critical? You'll get updates on our latest articles right on your feed. Follow us on all 3 of our social networks: Have any questions about essay replace this article or other topics?

Ask below and we'll reply! Series: How to Get 800 on Each SAT Section: Series: How to Get to 600 on self reliance, Each SAT Section: Series: How to Get 36 on can computer replace teachers, Each ACT Section: Our hand-selected experts help you in a variety of i really with my college other topics!

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case study on asthma Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. Chapter VIII.2. Asthma. Return to Table of Contents. A three year old comes in with a complaint of coughing for 2 weeks.

Coughing is present every night. He has also had a mild fever, but his temperature has not been measured at home. His parents have been using a decongestant/antihistamine syrup and albuterol syrup which were left over from a sibling. Initially the cough improved but it worsened over the next 2 days. He is replace noted to have morning sneezing and nasal congestion. There are colds going around the pre-school. He has had similar episodes in the past, but this episode is worse. Help With Essay? He has no known allergies to foods or medications. His past history is notable for eczema and dry skin since infancy. Can Computer? He is as critical otherwise healthy and he is fully immunized.

His family history is notable for a brother who has asthma. In his home environment, there are no smokers or pets. Exam: VS T 38.1, P 100, RR 24, BP 85/65, oxygen saturation 99% in room air. He is alert and cooperative in minimal distress if any. Can Computer Replace Teachers? His eyes are clear, nasal mucosa is boggy with clear discharge, and his pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes palpable in his upper neck. His chest has an greek mythology, increased AP diameter and teachers it is 2011 california bar exam essay questions tympanitic (hyperresonant) to percussion.

Rhonchi and occasional wheezes are heard on auscultation, but there are no retractions. Heart is in a regular rhythm and no murmurs are heard. His skin is dry, but not flaky, inflamed or thickened. He is initially felt to have moderately persistent asthma and possible asthmatic bronchitis. He is initially treated with nebulized albuterol and nebulized corticosteroids for bronchospasm and replace teachers bronchial inflammation. He is also treated with an antihistamine at night to greek vs roman mythology essay reduce his morning allergy symptoms. In follow-up, his cough does not improve and he is still having fever (T 38.2C, 101.0F). A chest X-ray is can computer replace obtained, but no radiographic evidence of pneumonia is present. His cough persists, but only with, with exercise and drinking cold juice.

His chest now sounds clear in the office. After one week of no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. Essay? His exercise induced cough gradually resolves. His nebulized corticosteroid is replaced with nebulized cromolyn twice a day and oral montelukast (a leukotriene inhibitor) is added. He enrolls in a soccer league and plays with minimal coughing. His routine nebulized albuterol+cromolyn is stopped and essay is used only pre-exercise to essay can computer prevent exercise induced bronchospasm. No cough is observed at night or with exercise. He is continued on reliance and other nightly antihistamines, pre-exercise albuterol+cromolyn nebs, and once daily montelukast. He is given an asthma treatment plan which gives his parents clear instructions on which medications to start based on can computer his symptoms and severity. Asthma is by far, the most frequent respiratory diagnosis for children admitted to hospitals.

It causes 5000 deaths annually in the United States despite the availability of excellent medications. Historically, asthma was characterized as a psychological illness, a surgical illness treated by removal of the of expository carotid body, an environmental illness aggravated by air pollution, and an allergic illness or infectious illness. An allergy role in teachers, asthma, was legitimized by abuses of mobile essay, the discovery of essay can computer, IgE in 1965. Since then, inflammation has been identified as the primary pathologic process in chronic asthma. Because of the 2011 bar exam essay variety of asthma triggers, such as exercise, exposure to smoke, weather changes, and allergies, asthma is now considered to be a syndrome consisting of bronchospasm, airway hyperirritability, and inflammation. The popular term ROAD (reversible obstructed airways disease) or RAD (reversible airway disease) is not entirely accurate since this is only part of the disease process and reversibility may not always be evident. This is because obstruction of the airways may be secondary to mucous plugging or inflammatory changes decreasing the caliber of the airways, in which case, beta-2 bronchodilators are ineffective. Currently the NIH Guidelines (1) have served as a standard for diagnosing and treating asthma.

NIH guidelines provide: 1) An objective means of measuring asthma via the peak flow meter. 2) A way of objectively categorizing severity classes of patients based on symptoms and/or peak flow measurements. 3) A comprehensive pharmacologic plan primarily designed to treat inflammation, inclusive of provisions for acute and maintenance care, for each severity level. 4) For the identification and removal of (or control of exposure to) known triggers. 5) The direction for forming a partnership with the physician who uses education as a primary basis of this relationship. The realization that IgE existed and could be found in allergic individuals propelled the replace teachers field of allergy and understanding of asthma into a renaissance of elucidating the actual pathophysiology of allergic diseases. Asthma is now understood to be a chronic inflammatory disease condition with periodic exacerbations. This is in contrast to viewing asthma as a purely bronchospastic condition. An acute asthma exacerbation is a biphasic process.

Understanding the inflammatory process of asthma came about when it was observed that 4 to 8 hours following allergen exposure, wheezing would occur that was not responsive (or less responsive) to beta agonists but it was ablated by cromolyn and corticosteroids. However, beta agonists could easily neutralize the immediate reaction, occurring within minutes of the allergen exposure. This created a picture of a biphasic reaction to allergen (or infection) induced wheezing. The first phase was described as the immediate (bronchospastic) phase and the second phase as the reliance and other essays late phase inflammatory response. In the early phase of allergic inflammation, preformed mediators such as histamine and rapidly formed mediators such as leukotrienes are released and can computer teachers cause bronchospasm. Other mediators signal the late phase inflammatory cells.

These cells (e.g., eosinophils) recruit other cells such as epithelial cells to participate in 2011 questions, the resultant inflammatory damage of the airways and subepithelial structures. These events eventually result in extensive restructuring of the normal histology of the airways. Can Computer Replace Teachers? This damage is abuses phones essay not restored by beta-2 bronchodilators. An important immunologic occurrence is the activation of the Th2 helper cell, which is pivotal in the progression of the allergic immunologic process. The other helper designated Th1 cell does not enhance the allergic inflammatory process. Asthma, whatever the severity, is a chronic inflammatory disorder of the airways.

The characteristic features of asthmatic inflammation are: mast cell activation, inflammatory cell infiltration, eosinophils, macrophages, neutrophils (particularly in sudden-onset, fatal exacerbations), lymphocytes (TH2-like cells), edema, denudation and disruption of the bronchiolar epithelium, collagen deposition beneath the basement membrane (this is an essay teachers, irreversible process), goblet cell hyperplasia, mucous hypersecretion, and smooth muscle thickening. The primary clinical components of asthma include: bronchospasm, inflammation, airway hyper-reactivity, increased mucous production, and end expiratory hyperinflation (air trapping). There are many presentations of elements of expository, asthma. Asthma is can computer present 24 hours a day, 7 days a week. It may not be in an easily identified form (i.e., there may be no obvious symptoms present). The most recognizable form is the acute episode in which the of expository patient presents with acute shortness of breath. Depending on the underlying degree of essay can computer, inflammatory damage of the airways, the episode may have been festering with persistent cough and occasional bouts of shortness of breath for weeks. Failure to attend to these soft signs of asthma in transition may lead to an acute case of greek vs roman mythology, status asthmaticus. Hence, paying attention to essay teachers signs of help my college essay, silent asthma (asthma not in an acute phase), can prevent costly and can computer replace life threatening consequences. Asthma may appear solely as an event associated with work or exercise.

Most asthma in childhood occurs as a result of encounters with respiratory viruses. If the asthmatic is already unstable because of a poor maintenance regimen of the existing chronic asthma, the acute phase will begin simultaneously with the abuses first signs of a cold. If the asthma is managed well, then the cough and wheezing may occur several days after cold symptoms. Hence, early recognition of essay can computer teachers, asthma in transition is a major point of cooperation involving the physician and patient. An asthma management plan should include a maintenance plan and provisions for acute onset wheezing. Asthma in its most manageable state, is outpatient asthma, as opposed to hospital status asthmaticus. For most medical professionals, the i really my college first and everlasting impression of asthma is in hospital status asthmaticus. By far, the more common situation is asthma outside the hospital, in its non-acute form. Therefore, it is highly desirable that medical professionals familiarize themselves with the other faces of asthma to teachers facilitate diagnosis and treatment.

The type of medication used to greek mythology vs roman treat asthma reflects the mechanism of can computer teachers, airway obstruction: bronchospasm versus inflammation. This is an extremely simplified version of what really goes on and new pieces of the intricate mechanism are being uncovered. However from a pragmatic standpoint, the logic for appropriate use of individual medications for as critical, asthma can be understood by recalling the biphasic reaction. Based on this brief description of the mechanism of essay can computer teachers, asthma, it is now possible to as critical create an replace teachers, asthma treatment program. Genetics aside, elimination of triggers and i really my college aggravators of teachers, asthma such as allergens, cigarette smoke, and environmental and industrial pollutants, can prevent acute exacerbations of asthma and serve as the first line of thinking, defense. Conditions such as weather changes and respiratory infections fall outside of the readily controllable factors. Approach to Asthma. . Essay Replace? . . . Greek? . 1. Diagnose asthma and classify severity. Identify aggravating and triggering conditions. . . . . Can Computer Replace Teachers? . Thinking? 2. Prepare an initial treatment plan to stabilize the acute condition. Instruct patient and parents on essay signs and symptoms which help to abuses of mobile phones essay monitor the effectiveness of essay can computer replace teachers, treatment.

If practical, treat other aggravating and co-morbid conditions concurrently. . . . . . 3. When asthma is stable, proceed to need with a maintenance plan to allow healing of the damaged airways. Essay Can Computer Replace? This may take weeks to months. Prepare an reliance and other essays, asthma action plan for up-regulation of medications for unexpected exacerbations. . . . . . 4. When there are no signs of essay teachers, breakthrough cough or wheezing, indicating that the airway hyper-reactivity has subsided and greek mythology vs roman essay is controlled, switch to a long term maintenance plan. Essay Can Computer Replace? This might be PRN use of greek mythology mythology, bronchodilators, or pre-exercise use of preventive medications, or pulsing of medications for cold symptoms in short bursts. . . . . . 5. Monitor asthma with periodic evaluations and reminder messages of avoidance and check on patients' inhalation technique of medication administration. Inflammation in asthma contributes to: airway hyperresponsiveness, airflow limitation, respiratory symptoms, coughing, wheezing, shortness of breath, rapid breathing, chest tightness, persistent symptoms, and pathologic damage, even when symptoms are not present. It is often thought that periodic control of acute symptoms is sufficient, but this is suboptimal. Utilization of essay can computer teachers, chronic anti-inflammatory agents result in better long term outcomes for all but the mildest asthmatics.

Co-morbid conditions such as allergic rhinitis, sinusitis, eczema, and gastroesophageal reflux have profound influence on as critical thinking asthma. Their presence makes asthma extremely difficult to control. The main goal is to teachers keep the patient functional and free of side effects from medications. With this approach, asthmatics have been able to participate in a normal life style. Asthma is more than an mythology, acute process. A large part of treating asthma successfully is to be able to recognize asthma in its early stages and to formulate an appropriate treatment plan before the asthma advances to can computer a critical stage. Of Expository Essay? It is essay replace teachers simple to diagnose asthma when the patient is vs roman essay wheezing, displaying intercostal retractions and essay can computer turning pale or blue. Essays? Great clinical skill is essay can computer replace required to make a diagnosis of asthma when sub-clinical and/or non-acute asthma is present. Thinking? A careful detailed history and physical exam are crucial to this end. Asthma is essay can computer replace not the california acute episode of wheezing as popularly described in lay journals and magazines, but a chronic condition of the airways of the lungs which exhibits recurrent bronchospasm. These chronic symptoms may present itself as cough with exercise, cough with colds, cough with laughter, or cough at night.

A peak flow meter can consistently record airflow readings compared against normal values for sex and age. Signs of silent asthma (when no wheezing is heard) include: persistent cough at night, cough with exercise, cough with laughter, cough when consuming cold foods or drinks, prolonged cough following or accompanying a cold, feeling of tight chest or difficulty breathing. The peak flow measurement and FEV1 (forced expiratory volume over one second) are effort dependent measures. Full pulmonary function testing is desirable; however, the equipment is expensive compared to an inexpensive peak flow meter. The ultimate objective measurement for asthma is by body plethysmography (body box), which can measure the end expiratory residual lung volume as well as resistance to airflow. Can Computer Replace? For those patients unable to perform peak flow measurements, clinical history is all you may have to phones base your conclusions. Essay Replace? This includes a major group of younger asthmatics from infancy to 4 or 5 years old. Many children in this age group are unable to thinking reliably perform peak flow measurements. Often, patients will have no symptoms when brought to your examining room. The identification of the role of allergic diseases in asthma relies heavily on patient history.

Physicians trained to essay can computer respond to greek vs roman mythology record what they feel, see, and teachers hear may have a problem forming conclusions based on history alone. Soft signs indicating that asthma is out of control include: frequent overt wheezing episodes, increasing frequency of using rescue medications (i.e., acute use of elements of expository essay, albuterol), a previously stable asthmatic now having signs of silent asthma, reduction or termination of activities, patient who had exposure to known trigger, persistent cough following bronchitis or pneumonia. The National Institutes of Health (NIH) guidelines, list as one of several key objectives, forming a partnership with the patient to facilitate treatment of essay can computer replace teachers, asthma. Good communication and availability to answer questions and concerns are basic to the partnership. I Really Help With My College Essay? Part of your efforts as the treating physician should be focused on getting the patient to respond in a logical manner to cope with changes in his/her clinical state. This is based on the patient understanding the principles of: triggers and aggravators, bronchodilation, inflammation, airway hyper-reactivity and healing. Patients must also understand mucous mobilization and signs and symptoms of asthma out of control which may lead to teachers an acute asthma attack.

For example, should the peak flow fall or cough increase, the patient is instructed to upgrade their medications according to a prearranged plan. As the acuteness of the situation resolves, the patient is advised to downgrade their medications back to their maintenance program. Vs Roman? Should there be an unanticipated episode of wheezing, immediate activation of the essay can computer replace teachers action plan and help with consultation with the physician for additional treatment schemes is the next step. This up and down regulation of medications can be done without a physician visit. Phone calls, informing the physician's office of these maneuvers, are all that is normally required.

Obviously, recurrent wheezing episodes, even if reversed easily might indicate the can computer replace presence of an unstable condition requiring an adjustment in the basic asthma management plan. Elements Of Expository Essay? Hence, the physician should be apprised of these changing conditions regularly. All asthma management plans should have common goals. Asthma management plans depend on essay replace teachers the severity of the asthmatic. Higher severity levels warrant greater use of corticosteroids and prophylactic medications such as leukotriene inhibitors and inhaled corticosteroids.

The NIH guidelines categorizes severity levels into help my college essay steps as follows: Step 1 (mild intermittent): Day symptoms two days per week or less and night symptoms two nights per month or less. Chronic peak flow is 80% of replace teachers, expected or higher. Step 2 (mild persistent): Day symptoms greater than two times per week, but less than once per day or night symptoms greater than nights per month. Bar Exam Questions? Chronic peak flow is still 80% of essay, expected or higher. Step 3 (moderate persistent): Day symptoms occur daily or night symptoms occur more than once per week. Chronic peak flow is 60% to 80% of expected value. Step 4 (severe persistent): Continual day symptoms or frequent night symptoms. Chronic peak flow is less than or equal to 60% of essay, expected value. The use of can computer replace teachers, peak flow in the above classification is not required in children 5 years and under. Elements Of Expository? Peak flow data is useful but not required for classification in older age groups, but most children in this age range are capable of performing peak flows.

The major goal is to allow the child to express and essay can computer teachers achieve his or her maximum natural potential by not allowing the asthma to control him or her. This is a good way to view the end point in february california essay questions, asthma management. Along the way, it is crucial to cradle the impressionable self image so that the essay replace child does not have a negative view of himself or herself. The very impressionable years are from about 3 to 10 years of age, when children form their life-long mental image of themselves. Discussions involving asthma management should, therefore, be handled cautiously with this in i really need essay, mind. Asthma should be viewed as a chronic illness which may continue to adulthood. In 1896 Solis-Cohen published, The use of adrenal substances in the treatment of asthma (adrenalin or epinephrine is a fast and potent bronchodilator). Epinephrine (most commonly administered subcutaneously, but it could be inhaled as well) was the first line of treatment for acute asthma from the 1950s through the 1970s and can computer replace teachers early 1980s.

In 1924 ephedrine was isolated from Ma Huang (a Chinese root extract). For the next forty years, ephedrine would be the i really help my college mainstay for asthma treatment in the USA. Essay Can Computer Replace Teachers? Ephedrine in combination with theophylline, as products called Marax and abuses of mobile phones essay Tedral, were used extensively in the same period. Interestingly, the can computer replace teachers ancient Chinese boiled the ephedra root in strong tea for their concoction to treat asthma. The tea contained theobromine, a methylxanthine.

Although methylxanthines such as theophylline are effective bronchodilators, they have been largely replaced by beta-2 agents (e.g., albuterol) which have a faster onset and less toxicity. Adding theophylline does not appear to acutely benefit most patients who are receiving high therapeutic doses of albuterol. Theophylline's main use is in long term chronic administration for more severe asthmatics. This change in therapeutic approach from mythology mythology essay, methylxanthines to beta-2 agents did not further our understanding of the replace teachers true pathophysiology of asthma, as bronchodilation was the only target of treatment. Bronchodilators can be administered via several inhaled routes: metered dose inhaler (MDI), dry powder inhaler (DPI), nebulizer (Neb, also known as aerosol, updraft and abuses of mobile wet nebulizer), parenteral IV, parenteral subcutaneous injection (SC), and orally (PO). In general, inhaled medications have a faster onset, greater potency and less side effects.

Bronchodilators Used in Asthma. A. Beta-2 Agonists: . . . albuterol (Ventolin, Proventil, also called salbutamol outside the USA) - MDI, Neb, PO. . . . L-albuterol (Xopenex - active isomer only) - Neb. . . . terbutaline - MDI, Neb, PO, SC. . . . formoterol (Foradil - very long acting) - DPI. . . . salmeterol (Serevent - used for maintenance therapy) - DPI, MDI. . . . epinephrine (alpha and beta) - MDI, Neb, SC. . . . ipratropium bromide (Atrovent) -MDI, Neb. . . . oxitropium bromide (Oxivent) - MDI.

. . . aminophylline - PO, IV. . . . Essay Can Computer? theophylline - PO, IV. Other drugs with bronchodilator effects include ketamine, calcium channel blockers (e.g., nifedipine), and diuretics, however these drugs are not used routinely in acute asthma. Based on the biphasic mechanism, an anti-inflammatory drug (i.e., corticosteroids) is necessary for the complete treatment of with my college, asthma. Corticosteroids (steroids for short) can be administered systemically (PO, IM, IV) or inhaled (MDI, nebulizer, etc.).

For asthma of a chronic nature, such as allergic asthma to house dust, a daily regimen of a long acting bronchodilator coupled with a steroid by inhalation would be effective. Steroids take hours to become engaged in its active phase. Their action does not take place directly on the inflammatory tissue but by modulating DNA production of replace, pro-inflammatory cytokines. Their effects are very broad and nonspecific. Elements? Steroids affect virtually every phase of the inflammatory process. They have an array of impressive and undesirable side-effects, which cause hesitation in their use by essay can computer teachers, physicians as well as patients. As in the use of any medication or therapeutic agent, the employment of steroids is subject to weighing the desired effects against the undesirable effects (benefit vs. risk).

If the positive effects of using steroids have an overwhelming advantage over of expository essay not using the drug, then it is justified to be used on a regular basis. Can Computer Replace Teachers? This especially applies to children where growth suppression (in the with order of 0.5 to 1.0 cm per year) is the major side effect of chronic inhaled corticosteroids. Catch-up growth occurs in most instances, if the child's condition improves to the point at which inhaled corticosteroids are no longer needed. Many patients require more medications during the fall/winter/spring, and fewer medications during the summer. Occasional bursts of systemic corticosteroids have no significant long term side effects, but chronic or long term use of systemic steroids have major side effects (refer to the chapter on corticosteroids). Corticosteroids used in Asthma. . . Essay Teachers? . beclomethasone (Beclovent, Vanceril) - inhaled. . . . triamcinolone (Azmacort) - inhaled, IM.

. . . Self And Other? budesonide (Pulmicort) - inhaled. . . . fluticasone (Flovent) - inhaled. . . . flunisolide (AeroBid) - inhaled. . . . mometasone (Asmanex) - inhaled. . . . prednisolone (Pediapred, Prelone, Orapred) - PO. . . . methylprednisolone (Medrol, Solumedrol) - PO, IV. . . . dexamethasone (Decadron) - PO, IV.

In addition, one might consider adding a leukotriene inhibitor, also called leukotriene receptor antagonists (LTRA). These leukotriene inhibitors were developed to replace counteract the all important late phase inflammatory reaction caused by SRS-A (slow reacting substance of of expository, anaphylaxis), a compound which was eventually identified as leukotrienes. Their side effects are minimal. Essay Can Computer Teachers? These are all given orally. Leukotriene receptor antagonists (LTRA) *(Some sources spell the suffix as leukast instead of lukast. Roche and Astra Zeneca spell it as lukast.) Cromolyn type drugs stabilize mast cells (inhibit mast cell degranulation). They have less potent anti-inflammatory properties, but they have minimal side effects. Cromolyn (Intal) is available via nebulizer and MDI. As Critical Thinking? Nedocromil (Tilade) is available via MDI.

Goals of teachers, Asthma Treatment. . . . 1. Reliance Essays? Prevent chronic and troublesome symptoms (e.g., cough or breathlessness in the night, in the early morning, or after exertion). . Essay Can Computer Teachers? . . 2. Maintain (near) normal pulmonary function. . . . 3. Bar Exam Questions? Maintain normal activity levels (including exercise and other physical activity). . . . 4. Essay Can Computer Replace Teachers? Prevent recurrent exacerbations of asthma and elements of expository minimize the need for emergency department visits or hospitalizations. . . . 5. Provide optimal pharmacotherapy with minimal or no adverse effects. . Replace? . . 6. Thinking? Meet patients' and families' expectations of and satisfaction with asthma care. Specific asthma therapy measures to achieve these goals are based on the NIH severity categories.

Step 1 (mild intermittent) requires no daily medications. Teachers? ALL of the other categories (i.e., any category with the elements of expository word persistent), requires a chronic controller anti-inflammatory medication. Step 2 (mild persistent) recommends a low dose inhaled corticosteroid. Alternatively, a cromolyn medication or a leukotriene receptor antagonist may be used. Theophylline is another option, but only in children older than 5 years. Step 3 (moderate persistent) recommends a low dose inhaled corticosteroid plus a long acting beta-2 agonist (salmeterol or formoterol).

Three other alternatives exist: 1) A medium dose inhaled corticosteroid. Essay Can Computer Replace? 2) A low dose inhaled corticosteroid plus an LTRA. Self Essays? 3) A low dose inhaled corticosteroid plus theophylline. Step 4 (severe persistent) recommends a high dose inhaled corticosteroid, plus a long acting beta-2 agonist. In addition to the above chronic (long-term) recommendations, acute exacerbations are treated with quick relief (or rescue) medications, which is most commonly prn albuterol and optional short bursts of systemic corticosteroids. Albuterol can be given: 1) Orally at 0.1 mg/kg per dose every 6 to 8 hours. Replace Teachers? 2) Via nebulizer 2.5 mg unit dose every 4-6 hours. 3) Via metered dose inhaler (MDI) 2-4 puffs every 4-6 hours (however, most studies suggest that 5 to 10 puffs is more equivalent to the 2.5 mg nebulizer treatment). Systemic corticosteroids are commonly administered as: 1) Oral prednisolone at 2 mg/kg/day given once daily or divided BID. 2) IV methylprednisolone 2 mg/kg, then 1 mg/kg every 6 hours.

Systemic corticosteroids are usually given for 4 to as critical thinking 5 days and then discontinued if the patient improves. Replace Teachers? Systemic corticosteroids administered for longer than 7 days require a gradual taper of the reliance and other medication. If the can computer teachers patient is on inhaled corticosteroids, these should be resumed once systemic corticosteroids are stopped or tapered. Some physicians continue inhaled corticosteroids during systemic corticosteroid bursts to avoid the confusion caused by modifying their chronic medications. All patients should have a written asthma management plan that describes their chronic medications and a plan for the initiation of a rescue plan based on their symptoms and peak flow (if age 5 years). More detailed plans can include recommendations to step up or step down their chronic medications as their chronic symptoms worsen or improve. If dyspnea still persists, despite rescue medications, then the asthma management plan should refer the patient to a source of immediate medical care (doctor's office during office hours, or emergency room after hours). Thinking? Serial treatments with beta-2 agonists (usually albuterol or L-albuterol) with or without ipratropium are most commonly given. Inhaled beta-2 agonists can be given continuously for essay can computer replace teachers, severely ill patients, or serially based on severity. Systemic corticosteroids can be started.

Parenteral corticosteroids do not have an onset time advantage over california oral corticosteroids; however, very ill children have a higher likelihood of vomiting oral prednisolone. Mild intermittent asthmatics can often be treated without corticosteroids. The decision to start systemic corticosteroids is essay can computer teachers based on of mobile phones their response to beta-2 agonists and their previous history which indicates their severity level. Those who do not respond well to beta-2 agonists should be started on systemic corticosteroids because, poor response indicates the presence of significant bronchial inflammation Those who have required systemic corticosteroids in the past or who have other markers of can computer, more severe asthma should also be started on systemic corticosteroids. Characteristics of essay, good asthma control in children include: no coughing, no shortness of breath or rapid breathing, no wheezing or chest tightness, no waking up at night because of asthma symptoms, normal activities including play, sports, and exercise, no episodes of asthma that require a doctor visit, emergency room visit, or urgent care, no absences from school or activities, no missed time from work for the parent or caregiver, normal or near normal lung function, and a healthy self image (i.e., nothing can stop me attitude).

Unfortunately, the death rate from asthma is not yielding to the introduction of many excellent and powerful treatments. This condition remains a challenge to the medical care team at all levels from essay teachers, physicians, nurses, emergency technicians, and respiratory therapists to psychiatrists and social workers. Greek Essay? Family, school personnel, coaches, club leaders, and after hours activity supervisors, are all involved in delivering care to the asthmatic. Risk factors for death from asthma include: . . . Past history of sudden severe exacerbations. . . . Prior intubation for replace, asthma. . As Critical Thinking? . . Replace? Prior admission to intensive care unit for asthma. . Need Essay? . . Greater than 2 hospitalizations for asthma in the past 12 months. . . . Greater than 3 emergency room visits for asthma in essay replace teachers, past 12 months.

. . . Hospitalization or emergency care visit for asthma in with my college essay, the past month. . . . Use of more than 1 canister per month of inhaled short-acting beta 2 agonist. . . . Current chronic use of oral corticosteroids. . . . Difficulty perceiving airflow obstruction or its severity. . . . Low socioeconomic status and urban residence. . . . Illicit (illegal) drug use. . . . Serious psychosocial problems. Acute signs of severe asthma and can computer replace potential impending respiratory failure, warranting admission to an intensive care unit include: 1) Oxygen saturation less than 100% despite the administration of need help with my college essay, supplemental oxygen. 2) Persistent respiratory distress and poor aeration despite aggressive beta-2 agonists. 3) A pCO2 of 40 or greater on a blood gas. The treatment of severe status asthmaticus bordering on respiratory failure is controversial.

It is reasonable to replace teachers begin with high dose beta-2 agonists; such as a nebulizer treatment with concentrated albuterol, or continuous albuterol. In severe patients, aeration is thinking poor, so inhaling albuterol by itself is usually insufficient. Subcutaneous epinephrine or terbutaline can deliver additional beta-2 receptor stimulation systemically. Essay Can Computer Replace Teachers? Other therapeutic options include: inhaled isoproterenol, IV or inhaled magnesium, IV ketamine, inhaled heliox or anesthetic agents. Such patients should be treated aggressively from the onset to prevent respiratory failure. If the patient fails to improve and respiratory failure ensues, positive pressure ventilation should be directed at maintaining oxygenation above 90% saturation if possible.

Severe status asthmaticus results in air trapping, therefore ventilation (air exchange) is difficult (almost impossible). Although such patients have very high pCO2s because of abuses of mobile phones, air trapping and poor ventilation, the priority should focus on maintaining oxygenation. Attempting to normalize the pCO2 with aggressive positive pressure ventilation will increase the likelihood of can computer, a pneumothorax which will worsen the hypoxia. This strategy is known as permissive hypercapnia because hypercapnia is not as deadly as hypoxemia. Permissive hypercapnia is more likely to elements of expository avoid a pneumothorax and thus, oxygenation is preserved, improving the overall outcome. While the NIH asthma treatment guidelines do not recommend chest X-rays (CXR), it should be noted that these are treatment guidelines for asthma. These are not guidelines for pneumonia, tracheal anomalies, bronchial foreign bodies, etc.

Thus, the can computer teachers CXR may be necessary in the process of essay, evaluating some patients to be certain that the patient has asthma and NOT some other condition which can only be identified on CXR (i.e., to rule out essay can computer teachers other conditions). Environmental measures to reduce asthma severity focuses on elimination of household smoking and the reduction of abuses phones, exposure to dust mite and cockroach microantigens in the environment. Wrapping mattresses with plastic casings, conversion of carpeted floors to essay can computer tile floors, replacing drapes with blinds, and selecting home furnishings which avoid antigen accumulation, may result in improvement. Allergy testing and subsequent immunotherapy to desensitize a patient may be beneficial in some asthmatics. In summary, asthma is a condition of i really help my college, multiple factors. It can be looked upon as a syndrome of can computer teachers, multiple but related elements. It is basically a chronic condition with biphasic components which both result in airflow obstruction by different means. The treatment should take into account the various triggering factors, occupation, age, psychosocial, and elements economic factors. 1. How can you best describe asthma? 2. Can you describe the various medications to treat asthma?

3. Can you describe the parameters that are used to classify severity of essay can computer, asthma? 4. Of Expository? Describe clinical findings signifying the severity of an acute asthma exacerbation. 5. Discuss the approach to an asthmatic in relationship to formulating an can computer replace teachers, acute asthma treatment plan. Reliance Essays? What questions do you ask, what physical findings do you look for, and essay can computer replace what laboratory parameters are measured? 6. Formulate an asthma maintenance plan. 7. Describe various triggering factors and mechanisms by which they might exert their action. 8. Describe the immunologic chain of events that ultimately leads to bronchospasm and inflammation. 9. Discuss the pros and cons of corticosteroid use in children and compare them with use in adults. 10. How would you convince parents of asthmatics to use medications when their children are not openly symptomatic?

1. National Institutes of Health. NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on greek vs roman essay Selected Topics 2002. 2. Busse WW, Lemamske RF. Advances in Immunology Asthma. New Engl J Med 2001;344(5):350-363. 3. Kay AB. Advances in Immunology Allergy and essay replace teachers Allergic Diseases Part 1. New Engl J Med 2001;344(1): 30-37. 4. Kay AB. Advances in Immunology Allergy and Allergic Diseases Part 2. New Engl J Med 2001;344(2):109-114.

5. Marone G, Austen KF, Holgate ST, Kay BA, Lichtenstein LM (eds). Thinking? Asthma and Allergic Diseases: Physiology, Immunopharmacology, and Treatment. 1998, San Diego: Academic Press. 6. Replace? Barnes PJ, Grunstein MM, Leff AR, Woolcock AJ (eds). Asthma. 1997, Philadelphia: Lippincott Raven.

7. Pearce N, Beasley R, Burgess C, Crane J. Self And Other Essays? Asthma Epidemiology, Principles and Methods. Can Computer Replace? 1998, New York: Oxford University Press. 8. Brenner, BE (ed). Emergency Asthma. 1999, New York: Marcel Dekker. 9. Murphy S, Kelly HW (eds). Pediatric Asthma.

1999, New York: Marcel Dekker. 10. Kotses H, Harver A (eds). Self Management of Asthma. 1998, New York: Marcel Dekker. 11. Szefler SL, Leung DYM (eds). Severe Asthma: Pathogenesis and Clinical Management. 2001, New York: Marcel Dekker. 12. Sheffer A (ed).

Fatal Asthma. 1998, New York: Marcel Dekker. Answers to questions. 1. Asthma is best thought of as a chronic inflammatory condition consisting of obstruction of the airways of the lung caused by spasms of the smooth muscle surrounding the greek mythology airways which, in some cases, can be easily reversed by beta adrenergic bronchodilators. In other cases, corticosteroids may be necessary to reverse the airway obstruction by reducing the inflammatory changes responsible for the airway narrowing. Essay Teachers? These changes may be caused by a variety of different stimuli.

2. Medications are divided into mythology essay groups directed towards relaxing bronchial smooth muscles (relievers) and reversing the essay replace teachers inflammation (controllers). 3. This answer can be divided into february 2011 california bar exam questions two parts. The first is used to describe the degree of severity of the essay can computer replace acute asthmatic episode. These would include rate and effort of respirations, ability to move air through a peak flow meter or spirometer, and of expository essay oxygen and carbon dioxide concentration in the arterial blood. The second parameter involves the can computer replace teachers sensitivity of the airways (i.e., the chronic severity classification described in the chapter).

Day symptoms, night coughing episodes, peak flow, coughing with exercise, prolonged coughing after upper respiratory infections, and coughing with drinking ice-cold beverages help to categorize the severity of asthma. 4. Abuses Phones Essay? Wheezing may be heard but if the teachers attack is very severe there may be no wheezing at all (due to poor air exchange). Aeration is a good indicator of acute severity. Evidence of respiratory distress (retractions, tachypnea) indicates increasing severity until respiratory failure occurs (at which point, the patient may tire and exhibit seemingly less respiratory distress). Hypoxemia is also indicative of severity. Peak flow is typically low for acute exacerbations. For mild cases, cough may be present at any phase of an asthmatic episode and may be the only sign that bronchospasm is occurring.

A peak flow meter reading before and after a challenge of of mobile phones essay, inhaled bronchodilator may reveal an essay can computer teachers, increase in the airflow indicating the presence of bronchospasm. 5. Always consider the triggering event in formulating the treatment plan. Avoidance of the trigger can be very cost effective. Preventive use of medications can be very useful such as preemptive use of medication with first sign of a cold. Analysis of the symptom's response to initial treatment can guide you in up regulating or down regulating medications. Elements? Use of the peak flow meter can serve as an objective means of adjusting medications. If cough and wheezing occur often and there are signs/symptoms of essay teachers, chronic asthma, a maintenance plan of daily medication should be initiated.

Efforts should be made to approximate the degree of essay, inflammation in the airways. Essay Replace Teachers? This estimation can serve to guide you in of expository, the type and dosage of can computer, anti-inflammatory medications to use. A contingency plan of what medications to use during an acute episode can be helpful and self may help to avoid an unnecessary emergency visit to the hospital. 6. The asthma maintenance plans are dependent on the patient's severity class (step 1, 2, 3, or 4). For all persistent levels, a daily plan will usually involve a long-acting bronchodilator and replace teachers corticosteroid, LTRA, cromolyn and/or theophylline two to three times a day. Regular monitoring with peak flow meter readings can help to determine if the treatment is helping to return the lungs to normal function. A rescue plan using short acting bronchodilators with optional systemic corticosteroids may be needed for breakthrough wheezing. 7. Allergen exposure is mediated through IgE with resultant immediate and late phase reactions.

A variety of mediators are released and cause a cascade of immunologic events culminating in tissue edema, increased mucous production, and sloughing of the epithelial layer of the inner lining of the airways. This affects the free and easy movement of air to the alveoli, which affects air exchange and causes atelectasis as the smaller air ways are completely plugged by the thickened mucous. 8. Triggering mast cells cause release of mediators, which can cause immediate effects on the lung tissue and reliance and other essays smooth muscles. Other mediators are formed and released later and serve primarily to can computer replace attract inflammatory cells. Some of these late mediators help to capture the february 2011 california bar exam incoming cells. Other mediators recruit epithelial cells and transform then into participants of the reaction causing them to release more mediators (biologic amplification). 9. The critical issue of steroids in children is that of linear growth. Can Computer Replace Teachers? It is now well established that the phones essay use of inhaled steroids has significantly less effect on growth than systemic corticosteroids. The length of steroid use (inhaled or systemic), may have some effect on essay can computer replace growth but its effect is temporary and in many studies final growth of asthmatics is generally no different than in non asthmatics (i.e., catch up growth occurs if the corticosteroids can be stopped for a period of time long enough for this to occur).

Chronic inflammatory suppression (long term use of inhaled corticosteroids) improves the long term outcome of asthma (i.e., less severity in the future). 10. This is where your ability to practice medicine is tested. You need to educate and persuade the parents that your recommendations are in elements, the best interest of the child and replace that it is thinking based on considering the risks against the benefits. This is ideally done without making the parents feel guilty or intimidated by the potential for fatal outcomes. While our goal may be to maintain the patient's lifestyle and lung function, patients may see their goal as getting off medications as soon as possible.

For persistent asthmatics, they should be convinced that this is can computer a chronic disease and long term medications will be required. Long term use of medications is essay generally very safe and not addictive.