Break Before University Essay Example for Free

Break Before University Essay It goes without saying that people like having the things they don’t have. Students always want to have a break after a long time they were very busy with studying, especially before they come to universities – a new environment with lots of challenging. It’ll be not good for a student to have a year break before going to university because it’s really a waste of time, and they might forget their knowledge. Today, both of adults and children always try to learn hard. Knowledge is unlimited; we never have everything in our mind. We learn bit by bit every day. If one stops working for one day, one eventually loses his knowledge. For one year, people can learn a lot of knowledge and experience, and you’ll be worse than others. Secondly, if you have a break for one year, it will take you more than one year to come back your work. In some case, the inertia is so great that one can’t go back to school.  Last but not least, one might forget your lessons easily when one doesn’t practice. When one comes to a university, one’ll continue learning your program in high school in a different way. One’ll have to learn by himself more than following teachers. It takes a lot of times to learn this new habit. Taking a long break seems like a cool idea, but I will not jeopardize my college education. A student will have to coup with many problems after such a break. One should consult his teachers and his parents before making that decision.

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay Bronchopulmonary dysplasia or BPD is a form of chronic lung disease that develops in preterm neonates and is treated with oxygen and positive-pressure ventilation (PPV). In this paper I will discuss exactly what bronchopulmonary dysplasia is, its pathophysiology, the etiology, its clinical presentation, and any differential diagnosis of the disease. I will also present in my research the treatment and management for the disease, its prognosis, and the sequelae. Bronchopulmonary dysplasia formerly known as Chronic Lung Disease of Infancy is a chronic lung disorder that is more prevalent in children who were born prematurely with low birthweights, and whose lungs havent had the time to fully develop. White male infants seem to be at a greater risk for development, and genetics may contribute to some of these cases. It is also very common in those who have received prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It is ironic that the treatment for RDS is considered to be the prime cause of BPD. With the treatment of RDS the patient is treated with high pressures and high FiO2 over a period of time. Its the high pressures of oxygen delivery that can result in necrotizing bronchiolitis and alveolar septal injury; this action further compromises the oxygenation of blood. Bronchopulmonary dysplasia is characterized by inflammation and scarring in the lungs. The signs and symptoms to watch out for are the oxygen deman ds of the infant not decreasing as they should, in some cases even increasing. Fast breathing, a fast heart rate, flared nostrils, retractions, poor weight gain, and coarse crackles may be heard upon auscultation. The pathophysiology of BPD is linked to four factors. These factors are oxygen toxicity, barotrauma, the presence of a PDA (patent ductus arteriosus), and fluid overload. Exposure to high concentrations of oxygen can lead to edema and the thickening of the alveolar membrane. When you have prolonged exposure it causes the alveolar tissues to hemorrhage and become necrotic. As the disease progresses the interstitial spaces will become fibrotic. When the lung tries to heal itself, all of the new cells are damaged by the same factors as before, and it continues in a cycle. All of this can interfere with alveolarization and lead to alveolar simplification with a reduction in the surface area for gas exchange. Any damage to the lung during a critical stage of growth will result in significant pulmonary dysfunction. With patients who have left-to-right shunting through the PDA it is more likely that they develop pulmonary congestion and worsening compliance. With this problem the patient wi ll need higher ventilatory pressures and oxygen percentages to help with ventilation and oxygenation; therefore they have a higher risk of BPD. Bronchopulmonary dysplasia develops as a result of an infants lungs becoming irritated or inflamed. The lungs of premature infants are very fragile and arent fully developed, and therefore they can become easily irritated. Ventilators are used to help with the breathing by using pressure to blow air into the airways and lungs. However it is the pressures used that can irritate and harm a premature infants lungs, so they are used only when absolutely needed. Sometimes oxygen therapy is given to make sure that the infants brains, hearts, livers, and kidneys get enough oxygen to work properly. However in some cases high levels of oxygen can inflame the lining of the lungs and injure the airways, it can also slow lung development. Another cause is infections that can inflame the underdeveloped lungs of premature infants. With this problem it causes narrowing of the airways and makes it harder for infants to breathe. Lung infections can also increase the need for extra oxygen and breathin g support which in turn leads to the ventilation and extra oxygen requirements. There are some studies also show that heredity plays a role in causing BPD. Infants with bronchopulmonary dysplasia will have abnormal findings on physical exams, chestx-rays, pulmonary function testing, and histopathologic examinations. Initial findings observed shortly after birth are consistent with respiratory distress syndrome (RDS). Persistence of these abnormalities can be associated with an increased risk of bronchopulmonary dysplasia. Physical examination may reveal tachypnea, tachycardia, increased work of breathing, including retractions, nasal flaring, and grunting, as well as frequent desaturations and significant weight loss during the first 10 days of life. Infants with severe bronchopulmonary dysplasia are often extremely immature and had a very low birth weight. Their requirements for oxygen and ventilatory support often increase in the first 2 weeks of life. At weeks 2-4, oxygen supplementation, ventilator support, or both are often increased to maintain adequate ventilation and oxygenation. Dif DX Atelectasis refers to collapse of part of the lung. It may include a lung subsegment or the entire lung and is almost always a secondary phenomenon, with no sex or race proclivities; however, it may occur more frequently in younger children than in older children and adolescents. The direct morbidity from atelectasis is transient hypoxemia due to blood flowing through the lung, which does not have normal air flow. The blood does not pick up oxygen from the corresponding alveoli. This shunting results in transient hypoxemia. Hypertension Patent ductus arteriosus (PDA) is one of the more common congenital heart defects. The presentation widely varies. Depending on the size of the patent ductus arteriosus, the gestational age of the neonate, and the pulmonary vascular resistance, a premature neonate may develop life-threatening pulmonary overcirculation in the first few days of life. Conversely, an adult with a small patent ductus arteriosus may present with a newly discovered murmur well after adolescence. During fetal life, the ductus arteriosus is a normal structure that allows most of the blood leaving the right ventricle to bypass the pulmonary circulation and pass into the descending aorta. Typically, only about 10% of the right ventricular output passes through the pulmonary vascular bed. Pneumonia and other lower respiratory tract infections are the leading causes of death worldwide. Because pneumonia is common and is associated with significant morbidity and mortality, properly diagnosing pneumonia, correctly recognizing any complications or underlying conditions, and appropriately treating patients are important. Although in developed countries the diagnosis is usually made on the basis of radiographic findings, the World Health Organization (WHO) has defined pneumonia solely on the basis of clinical findings obtained by visual inspection and on timing of the respiratory rate. (See Clinical Presentation.) Pneumonia may originate in the lung or may be a focal complication of a contiguous or systemic inflammatory process. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms. These derangements often significantly alter gas exchange and dependent cellular metabolism in the many tissues and organs that determine survival and contribute to quality of life. Subglottic stenosis (SGS) is a narrowing of the subglottic airway (see image below), which is housed in the cricoid cartilage. The subglottic airway is the narrowest area of the airway because it is a complete, nonexpandable, and nonpliable ring, unlike the trachea, which has a posterior membranous section, and the larynx, which has a posterior muscular section. Tracheomalacia is a structural abnormality of the tracheal cartilage allowing collapse of its walls and airway obstruction. A deficiency and/or malformation of the supporting cartilage exists, with a decrease in the cartilage-to-muscle ratio. Immaturity of the tracheobronchial cartilage is thought to be the cause in type I, whereas degeneration of previously healthy cartilage is thought to produce other types. Inflammatory processes, extrinsic compression from vascular anomalies, or neoplasms may produce degeneration. Diffuse malacia of the airway of the congenital origin improves by age 6-12 months as the structural integrity of the trachea is restored gradually with resolution of the process. Treatment and management Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU. Such treatment usually includes: Using radiant warmers or incubators to keep infants warm and reduce the chances of infection. Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies bodies. Using sensors on fingers or toes to check the amount of oxygen in the infants blood. Giving fluids and nutrients through needles or tubes inserted into the infants veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats. Checking fluid intake to make sure that fluid doesnt build up i n the babies lungs. As their condition improves, babies who have BPD are weaned or taken off NCPAP or ventilators slowly, until they can breathe on their own. These infants will likely need to continue getting oxygen therapy for some time. If your infant has moderate to severe BPD, echocardiography may be done every few weeks to months to check his or her pulmonary artery pressure. If your child needs long-term support from a ventilator, he or she will likely have a tracheostomy (TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your childs doctor will put the breathing tube from the ventilator through the hole. Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.) Long-term use of an endotracheal tube can damage the trachea. This damage may later r equire surgery to correct. A tracheostomy may allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your childs muscles and clear mucus out of his or her lungs.Infants who have BPD can recover, but many spend several weeks or months in the hospital. This allows them to get the care they need. Before your baby goes home, its important for you to learn as much as you can about your childs condition and how its treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital. Your child will likely continue on all or some of the treatments that were started at the hospital, including:Medicines, such as bronchodilators, steroids, diuretics, and caffeine. Oxygen therapy and/or breathing support from NCPAP or a ventilator. Extra nutrition and calories, which may be given through a feeding tube. Pre ventive treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infants-especially those in high-risk groups-RSV can be more serious, leading to severe breathing problems. Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist may help with long-term medical care and make treatment recommendations. Mechanical ventilation In most cases of bronchopulmonary dysplasia (BPD), respiratory distress syndrome is diagnosed and treated. The mainstay for treating RDS has been surfactant replacement with oxygen supplementation, continuous positive airway pressure (CPAP), and mechanical ventilation. The treatment necessary to recruit alveoli and prevent atelectasis in the immature lung may cause lung injury and activate the inflammatory cascade. Trauma secondary to positive pressure ventilation (PPV) is generally referred to as barotrauma. With the recent focus on a ventilation strategy involving low versus high tidal volume, some investigators have adopted the term volutrauma. Volutrauma suggests the occurrence of lung injury secondary to excessive tidal volume from PPV. The severity of lung immaturity, the fetal milieu, and the effects of surfactant deficiency determine the need for PPV, surfactant supplementation, and resultant barotrauma or volutrauma. With severe lung immaturity, the total number of alveoli is reduced, increasing the positive pressure transmitted to distal terminal bronchioles. In the presence of surfactant deficiency, surface tension forces are increased. Some compliant alveoli may become hyperinflated, whereas other saccules with increased surface tension remain collapsed. With increasing PPV to recruit alveoli and improve gas exchange, the compliant terminal bronchiole and alveolar ducts may rupture, leaking air into the interstitium, with resultant pulmonary interstitial emphysema (PIE). The occurrence of PIE greatly increases the risk of bronchopulmonary dysplasia. Many modes of ventilation and many ventilator strategies have been studied to potentially reduce lung injury, such as synchronized intermittent mechanical ventilation (SIMV), high-frequency jet ventilation (HFJV), and high-frequency oscillatory ventilation (HFOV). Results have been mixed, although some theoretical benefits are associated with these alternative modes of ventilation. Although shorter duration of mechanical ventilation has been demonstrated in some trials of SIMV, most trials have not had a large enough sample size to demonstrate a reduction in bronchopulmonary dysplasia. Systematic reviews suggest that optimal use of conventional ventilation may be as effective as HFOV in improving pulmonary outcomes. Regardless of the high-frequency strategy used, avoidance of hypocarbia and optimization of alveolar recruitment may decrease the risk of bronchopulmonary dysplasia and associated of neurodevelopmental abnormalities. PPV with various forms of nasal CPAP has been reported to decrease injury to the developing lung and may reduce the development of bronchopulmonary dysplasia. In general, centers that use gentler ventilation with more CPAP and less intubation, surfactant, and indomethacin had the lowest rates of bronchopulmonary dysplasia. Oxygen and PPV frequently are life-saving in extremely preterm infants. However, early and aggressive CPAP may eliminate the need for PPV and exogenous surfactant or facilitate weaning from PPV. Some recommend brief periods of intubation primarily for the administration of exogenous surfactant quickly followed by extubation and nasal CPAP to minimize the need for prolonged PPV. This strategy may be most effective in infants without severe RDS, such as many infants with birth weights of 1000-1500 g. In infants who require oxygen and PPV, careful and meticulous treatment can minimize oxygen toxicity and lung injury. Optimal levels include a pH level of 7.2-7.3, a partial pressure of carbon dioxide (pCO2) of 45-55 mm Hg, and a partial pressure of oxygen (pO2) level of 50-70 mm Hg (with oxygen saturation at 87-92%). Assessment of blood gases requires arterial, venous, or capillary blood samples. As a result, indwelling arterial lines are often inserted early in the acute management of RDS. Samples obtained from these lines provide the most accurate information about pulmonary function. Arterial puncture may not provide completely accurate samples because of patient agitation and discomfort. Capillary blood gas results, if samples are properly obtained, may be correlated with arterial values; however, capillary samples may widely vary, and results for carbon dioxide are poorly correlated. Following trends in transcutaneous PO2 andP CO2 may reduce the need for frequent blood gas measurements. Weaning from mechanical ventilation and oxygen is often difficult in infants with moderate-to-severe bronchopulmonary dysplasia, and few criteria are defined to enhance the success of extubation. When tidal volumes are adequate and respiratory rates are low, a trial of extubation and nasal CPAP may be indicated. Atrophy and fatigue of the respiratory muscles may lead to atelectasis and extubation failure. A trial of endotracheal CPAP before extubation is controversial because of the increased work of breathing and airway resistance. Optimization of methylxanthines and diuretics and adequate nutrition may facilitate weaning the infant from mechanical ventilation. Meticulous primary nursing care is essential to ensure airway patency and facilitate extubation. Prolonged and repeated intubations, as well as mechanical ventilation, may be associated with severe upper airway abnormalities, such as vocal cord paralysis, subglottic stenosis, and laryngotracheomalacia. Bronchoscopic evaluation should be considered in infants with bronchopulmonary dysplasia in whom extubation is repeatedly unsuccessful. Surgical interventions (cricoid splitting, tracheostomy) to address severe structural abnormalities are used less frequently today than in the past. Oxygen therapy Oxygen can accept electrons in its outer ring to form free radicals. Oxygen free radicals can cause cell-membrane destruction, protein modification, and DNA abnormalities. Compared with fetuses, neonates live in a relatively oxygen-rich environment. Oxygen is ubiquitous and necessary for extrauterine survival. All mammals have antioxidant defenses to mitigate injury due to oxygen free radicals. However, neonates have a relative deficiency in antioxidant enzymes. The major antioxidant enzymes in humans are superoxide dismutase, glutathione peroxidase, and catalase. Activity of antioxidant enzymes tend to increase during the last trimester of pregnancy, similar to surfactant production, alveolarization, and development of the pulmonary vasculature. Increases in alveolar size and number, surfactant production, and antioxidant enzymes prepare the fetus for transition from a relatively hypoxic intrauterine environment to a relatively hyperoxic extrauterine environment. Preterm birth exposes the neonate to high oxygen concentrations, increasing the risk of injury due to oxygen free radical. Animal and human studies of supplemental superoxide dismutase and catalase supplementation have shown reduced cell damage, increased survival, and possible prevention of lung injury. Evidence of oxidation of lipids and proteins has been found in neonates who develop bronchopulmonary dysplasia. Supplementation with superoxide dismutase in ventilated preterm infants with RDS substantially reduced in readmissions compared with placebo-treated control subjects. Further trials are currently under way to examine the effects of supplementation with superoxide dismutase in preterm infants at high risk for bronchopulmonary dysplasia. Ideal oxygen saturation for term or preterm neonates of various gestational ages has not been definitively determined. In practice, many clinicians have adopted conservative oxygen saturation parameters (ie, 87-92%). A delicate balance to optimally promote neonatal pulmonary (alveolar and vascular) and retinal vascular homeostasis is noted. In the Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) trial to reduce severe retinopathy of prematurity (ROP), oxygen saturations of more than 95% minimally affected retinopathy but increased the risk for pneumonia or bronchopulmonary dysplasia. The normal oxygen requirement of a preterm infant is unknown. Pulmonary hypertension and cor pulmonale may result from chronic hypoxia and lead to airway remodeling in infants with severe bronchopulmonary dysplasia. Oxygen is a potent pulmonary vasodilator that stimulates the production of nitric oxide (NO). NO causes smooth muscle cells to relax by activating cyclic guanosine monophosphate. Currently, pulse oximetry is the mainstay of noninvasive monitoring of oxygenation. Repeated episodes of desaturation and hypoxia may occur in infants with bronchopulmonary dysplasia receiving mechanical ventilation as a result of decreased respiratory drive, altered pulmonary mechanics, excessive stimulation, bronchospasm, and forced exhalation efforts. Forced exhalation efforts due to infant agitation may cause atelectasis and recurrent hypoxic episodes. Hyperoxia may overwhelm the neonates relatively deficient antioxidant defenses and worsen bronchopulmonary dysplasia. The patients oxygen requirements are frequently increased during stressful procedures and feedings. Some NICUs have adopted a conservative oxygen saturation policy of maintaining saturations of 88-94%. Caregivers are more likely to follow wide guidelines for ranges of oxygen saturation than narrow ones. Some infants, especially those living at high altitudes, may require oxygen therapy for many months. Transfusion of packed RBCs may increase oxygen-carrying capacity in preterm infants who have anemia (hematocrit The need for multiple transfusions and donor exposures can be minimized by using iron supplementation, a reduction in phlebotomy requirements, and by use of erythropoietin administration. Treatment of inflammation Elevated levels of interleukin-6 and placental growth factor in the umbilical venous blood of preterm neonates are associated with increased incidence of bronchopulmonary dysplasia. This inflammation likely affects alveolarization and vascularization of the pulmonary system of the second-trimester fetus. Fetal sheep exposed to inflammatory mediators or endotoxin develop inflammation and abnormal lung development. Activation of inflammatory mediators has been demonstrated in humans and animal models of acute lung injury. Activation of leukocytes after cell injury caused by oxygen free radicals, barotrauma, infection, and other stimuli may begin the process of destruction and abnormal lung repair that results in acute lung injury then bronchopulmonary dysplasia. Radiolabeled activated leukocytes have been recovered by means of bronchoalveolar lavage (BAL) in preterm neonates receiving oxygen and PPV. These leukocytes, as well as lipid byproducts of cell-membrane destruction, activate the inflammatory cascade and are metabolized to arachidonic acid and lysoplatelet factor. Lipoxygenase catabolizes arachidonic acid, resulting in the production of cytokines and leukotrienes. Cyclooxygenase may also metabolize these byproducts to produce thromboxane, prostaglandin, or prostacyclin. All of these substances have potent vasoactive and inflammatory properties. levels of these substances are elevated in the first days of life, as measured in tracheal aspirates of preterm infants who subsequently develop bronchopulmonary dysplasia. Metabolites of arachidonic acid, lysoplatelet factor, prostaglandin, and prostacyclin may cause vasodilatation, increase capillary permeability with subsequent albumin leakage, and inhibit surfactant function. This effects increase oxygenation and ventilation requirements and potentially increase rates of bronchopulmonary dysplasia Activation of transcription factors such as nuclear factor-kappa B in early postnatal life is associated with death or bronchopulmonary dysplasia. Collagenase and elastase are released from activated neutrophils. These enzymes may directly destroy lung tissue because hydroxyproline and elastin (breakdown products of collagen and elastin) have been recovered in the urine of preterm infants who develop bronchopulmonary dysplasia. Alpha1-proteinase inhibitor mitigates the action of elastases and is activated by oxygen free radicals. Increased activity and decreased function of alpha1-proteinase inhibitor may worsen lung injury in neonates. A decrease in bronchopulmonary dysplasia and in the need for continued ventilator support is found in neonates given supplemental alpha1-proteinase inhibitor. All of these findings suggest the fetal inflammatory response effects pulmonary development and substantially contributes to the development of bronchopulmonary dysplasia. The self-perpetuating cycle of lung injury is accentuated in the extremely preterm neonate with immature lungs. Management of infection Maternal cervical colonization and/or colonization in the neonate with Ureaplasma urealyticum has been implicated in the development of bronchopulmonary dysplasia. Viscardi and colleagues found that persistent lung infection with U urealyticum may contribute to chronic inflammation and early fibrosis in the preterm lung, leading to pathology consistent with clinically significant bronchopulmonary dysplasia.[13] Systematic reviews have concluded that infection with U urealyticum is associated with increased rates of bronchopulmonary dysplasia. Infection-either antenatal chorioamnionitis and funisitis or postnatal infection-may activate the inflammatory cascade and damage the preterm lung, resulting in bronchopulmonary dysplasia. In fact, any clinically significant episode of sepsis in the vulnerable preterm neonate greatly increases his or her risk of bronchopulmonary dysplasia, especially if the infection increases the babys requirement for oxygen and mechanical ventilation. Future management Future management of bronchopulmonary dysplasia will involve strategies that emphasize prevention. Because few accepted therapies currently prevent bronchopulmonary dysplasia, many therapeutic modalities (eg, mechanical ventilation, oxygen therapy, nutritional support, medication) are used to treat bronchopulmonary dysplasia. Practicing neonatologists have observed reduced severities of bronchopulmonary dysplasia in the postsurfactant era. Maintaining PPV and oxygen therapy for longer than 4 months and discharging patients to facilities for prolonged mechanical ventilation is now unusual. Medication Summary Many drug therapies are used to treat infants with severe bronchopulmonary dysplasia (BPD). The efficacy, exact mechanisms of action, and potential adverse effects of these drugs have not been definitively established. A study group from the NICHD and US Food and Drug Administration (FDA) reviewed many of the drugs used to prevent and treat bronchopulmonary dysplasia. Walsh and colleagues concluded that detailed analyses of many of these treatments, as well as long-term follow-up, are needed.[15] Vitamin A supplementation Seven trials of vitamin A supplementation in preterm neonates to prevent bronchopulmonary dysplasia were analyzed for the Cochrane Collaborative Neonatal review. Vitamin A supplementation reduced bronchopulmonary dysplasia and death at 36 weeks postmenstrual age. However, the need for frequent intramuscular injections in extremely premature infants has precluded widespread use of this therapy. Diuretics Furosemide (Lasix) is the treatment of choice for fluid overload in infants with bronchopulmonary dysplasia. It is a loop diuretic that improves clinical pulmonary status and function and decreases pulmonary vascular resistance. Daily or alternate-day furosemide therapy may facilitate weaning from positive pressure ventilation (PPV), oxygenation, or both. Adverse effects of long-term therapy are frequent and include hyponatremia, hypokalemia, contraction alkalosis, hypocalcemia, hypercalciuria, renal stones, nephrocalcinosis, and ototoxicity. Careful parenteral and enteral nutritional supplementation is required to maximize the benefits instead of exacerbating the adverse effects. In patients with mild hyponatremia or hypokalemia, supplementation with potassium chloride is favored over supplementation with sodium chloride. Thiazide diuretics plus aldosterone inhibitors (eg, spironolactone [Aldactone]) have also been used in infants with bronchopulmonary dysplasia. In several trials of infants with bronchopulmonary dysplasia, thiazide diuretics combined with spironolactone increased urine output with or without improvement in pulmonary mechanics. Hoffman et al reported that spironolactone did not reduce the need for supplemental electrolytes in preterm infants with bronchopulmonary dysplasia.[16] To the present authors knowledge, long-term studies to compare the efficacy of furosemide with those of thiazide and spironolactone therapy have not been performed. Bronchodilators Albuterol is a specific beta2-agonist used to treat bronchospasm in infants with bronchopulmonary dysplasia. Albuterol may improve lung compliance by decreasing airway resistance by relaxing smooth muscle cell. Changes in pulmonary mechanics may last as long as 4-6 hours. Adverse effects include increased blood pressure (BP) and heart rate. Ipratropium bromide is a muscarinic antagonist that is related to atropine; however, it may have bronchodilator effects more potent than those of albuterol. Improvements in pulmonary mechanics were demonstrated in patients with bronchopulmonary dysplasia after they received ipratropium bromide by inhalation. Combined therapy with albuterol and ipratropium bromide may be more effective than either agent alone. Few adverse effects are noted. Methylxanthines are used to increase respiratory drive, decrease apnea, and improve diaphragmatic contractility. These substances may also decrease pulmonary vascular resistance and increase lung compliance in infants with bronchopulmonary dysplasia, probably by directly causing smooth muscle to relax. Methylxanthines also have diuretic effects. All of these effects may increase success in weaning patients from mechanical ventilation. Synergy between theophylline and diuretics has been demonstrated. Theophylline has a half-life of 30-40 hours. It is metabolized primarily to caffeine in the liver and may result in adverse effects such as increase in heart rate, gastroesophageal reflux, agitation, and seizures. The half-life of caffeine is approximately 90-100 hours, and caffeine is excreted unchanged in the urine. Both agents are available in intravenous and enteral formulations. Caffeine has fewer adverse effects than theophylline. Schmidt and colleagues reported that the early use of caffeine to treat apnea of prematurity appeared to reduce ventilatory requirements and that it may decrease the incidence of bronchopulmonary dysplasia.[17] Corticosteroids Systemic and inhaled corticosteroids have been studied extensively in preterm infants to prevent and treat bronchopulmonary dysplasia. Dexamethasone is the primary systemic synthetic corticosteroid studied in preterm neonates. Dexamethasone has many pharmacologic benefits but clinically significant adverse effects. This drug stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, inhibits prostaglandin and leukotriene, decreases pulmonary edema (PE), breaks down granulocyte aggregates, and improves pulmonary microcirculation. Its adverse effects are hyperglycemia, hypertension, weight loss, GI bleeding or perforation, cerebral palsy, adrenal suppression, and death. Many researchers have evaluated the effects of early administration of dexamethasone to prevent bronchopulmonary dyspl

Utopia Essay -- essays research papers fc

Thomas More’s, Utopia is one of the most politically and socially influential texts to date. His audience, which ranges from academic and social scholars to college students, all can gain a different understanding of the work and it’s meaning. In order to fully comprehend More’s message, one must have an appreciation for the time and culture in which he lived. After grasping historical concepts, one reads Utopia, not as just a volume recounting a fictitious island society, but rather as a critique on a time of corruption and reformation. Throughout the entire text, More’s personal views on the religion, politics, and economy of this turbulent time seep through the carefully plotted thread of this critical work.   Ã‚  Ã‚  Ã‚  Ã‚  More is seen in history through many different lights. It is difficult to historically describe the sixteenth century without mentioning More’s individual involvement as a key religious and political figure of the time. In his early life, he focuses mainly on his desire for priesthood. More lived in a monastery for years and pursued the pious life of the Carthusians only to abandon it for a political career. Many speculate that More’s reasons for leaving had to do with the corruption he witnessed in his time there and desire to engage in matrimony. The corruption and greed forming among the clergy is what triggered the Protestant Reformation, led by Martin Luther. Next, More entered into the political spotlight through parliament and as a Speaker of the House of Commons, where he spent his energy encouraging the idea of freedom of speech. His next duty was Chancellor of the Duchy of Lancester, followed by the Lord Chancellor. Both of these came towar ds the end of his political and judicial career when his views began to split from those of Henry VIII. More’s disagreement with the ideas of Henry VIII and the conversion to Lutheranism was eventually the end of him, when he was beheaded for refusing to swear to the Oath of Supremacy and Act of Succession. He believed in the way of the Catholic Church till the end and paid the ultimate sacrifice of his life.   Ã‚  Ã‚  Ã‚  Ã‚  Evidence of More’s religious views is found throughout the text. He cleverly disguises his true opinions by inventing a fictitious traveler by the name of Raphael Hythloday, who the reader believes to be the originator of the radical ideas.... ... More spends a great deal of time in Book 1 on a conversation in which Raphael is expressing sympathy for the poor. More was rumored to also display this tendency in his life. In More’s time, the poor were at their poorest while the rich were getting richer. Food, clothing, etc, became a luxury to the homeless peasants, who often resorted to thievery.   Ã‚  Ã‚  Ã‚  Ã‚  In conclusion, More used an interesting characterization method to write a blatant critique of the societal constructs that he lived in. This was a dangerous task to undertake in a time when heresy and treason were punishable by death. More’s life achievements conflict with some of the views in his work, but that is why he calls it fiction. More lived a life of great determination and devotion. His strict lifestyle and critical analysis of the world that surrounded him served as the perfect exposition for a world that only existed in his mind. To close, a quote from Book I, Hythloday states, â€Å"You must strive to influence policy indirectly, handle the situation tactfully, and thus what you cannot turn to good, you may at least—to the extent of your powers—make less bad†(26). Works Cited

Creating Text Essay -- Writing Technology Technological Papers

Creating Text The process of creating â€Å"text† without using technology appeared to be a simple task that would allow the students to be a creator of his or her unique technology free masterpiece. I just had to come up with a creative, natural way to write text instead of using modern technologies that society takes for granted. How hard and restrictive could this assignment be? I soon found out everything would not go exactly as planned. It took me two attempts and failures before I finally achieved some level of success. My first idea came to me while I was getting ready one morning. Why not use hair to create text! It is a natural part of the human body that is constantly growing, natural and indispensable. I could have taken hair, looped and knotted several clumps together to make letters and then placed those letters to spell out text on any surface. The hair would be portable but undoing the formed letters to create newly formed letters would have been time consuming and difficult. I have several friends who cut hair for a living and I could have easily had them give me hair they cut from their customers. I also attempted to ask my sister for her hair; she has dread locks which would have been easier to work with since they are so thick but she didn’t want to part with them for a homework assignment. The more I thought about this idea the more I realized how time consuming and unrealistic it would be. Using hair would be a creative way to develop text but I would need m ass quantities and lots of patience. My second idea came to me when I took a trip to the grocery store. I went to the produce section and circled around the stands looking for some piece of fruit or vegetable that ... ...gh the writing process can be revised, edited, and visually reviewed where speech is spur of the moment and final. Traditionalists often resisted writing and viewed the process as unnatural and untrustworthy (Dennis Baron 39). However, speech seems to demand more trust because the individual is exposing themselves to their audience which subjects them to high levels of criticism. Overall, this project has exposed the mechanics and technology involved in the writing process. Up until this point I put little thought or recognition into the process I use so widely on a regular basis. After the amount of time, energy, and thought that went in to my attempt to create â€Å"natural† writing mechanics and tools the frustration isn’t worth what seems to be a small victory. In the end the process of trying to think of something natural to create is unnatural.

booker t :: essays research papers

Booker T. Washington The purpose for writing on Booker T. Washington is to focus on his educational contributions, and the different speeches he gave during and after the 19th century for African American and for the institution. Booker was born into slavery on a small tobacco plantation on April 5 1856. While in grade school he did not have a last name. When he realized that all of the other children at the school had a second name, and the teacher asked him his, he invented the name Washington. For the first nine years of his life until 1865 when the close of the Civil War emancipated the boy Booker and the remainder of his race, he like many other Americans of dark skin had been considered a piece of property on a Southern plantation. Any education extraneous to their enforced labor had been forbidden to most Negroes in the South. By 1895 however, in his historic Atlanta Exposition Address, Washington was to say: Starting thirty years ago with ownership here and there in a few quilts and pumpkins and chickens (gathered from miscellaneous sources), remember the path that has led from these to the inventions and production of agricultural implements, buggies, steam engines, newspapers, books, statuary, carving, paintings, the management of drug-stores and banks, has not been trodden without contact with thorns and thistles.1 This famous speech placed Washington in the national spotlight as the leader of his race. How did he rise to the top? What were the methods he used to raise his people, and how did he discover those ways? In 1881 citizens in Tuskegee, Alabama, asked Hampton's president to recommend a white man to head their new black college; he suggested Washington instead. The school had an annual legislative appropriation of $2,000 for salaries, but no campus, buildings, pupils, or staff.

Importance of Technical Education Essay

Technical Education plays a vital role in human resource development of the country by creating skilled manpower, enhancing industrial productivity and improving the quality of life. Technical Education covers courses and programmes in engineering, technology, management, architecture, town planning, pharmacy and applied arts & crafts, hotel management and catering technology. The technical education system in the country can be broadly classified into three categories – Central Government funded institutions, State Government/State-funded institutions & Self-financed institutions. The 65 Centrally funded institution of technical and science education are as under: IITs | 15| IIMs | 13| IISc. , Bangalore| 1| IISERs| 5| NITs| 30| IIITs| 4| NITTTRs| 4| Others (SPA, ISMU, NERIST, SLIET, NITIE & NIFFT, CIT)| 9| TOTAL| 81| Besides the above, there are four Boards of Apprenticeship Training (BOATs). The Central Government is also implementing the following schemes/programmes: – (i) Technical Education Quality Improvement Programme (TEQIP) assisted by the World Bank. (ii) Indian National Digital Library for Science & Technology (INDEST). There is one Public Sector Undertaking, namely, Educational Consultants India Ltd. (Ed. CIL) under the Ministry. There are also Apex Councils, namely the All India Council for Technical Education (AICTE) and Council of Architecture (COA). IMPORTANCE OF TECHNICAL EDUCATION. Education is important for every individual in a nation. It plays a vital role to change the stare of a country. No country could bring a revolution in it unless its everybody are educated enough to meet the challenges. Education makes a man realize about himself and his goals and how to achieve that goals. Basically, Education is divided into three groups. The Education which teaches the concerns of a society is called Social Education. The Education which develops a personality inside a man himself is called Spiritual Education. The Education that concerns with the professionalism is called Vocational Education. The Technical Education comes under the branch of Vocational Education which deals practically in the field of trade, commerce, agriculture, medicine & Engineering. We are living in the modern age of science where we found Technologies in every aspect of life. What makes life so brain friendly for us simply; these are the Technologies which we use for our ease and comforts. Not only in our daily life but also in the research centre, in defensive measured of a country, biological aspects etc. No nation could generate the progress unless it promotes technical aspects in its fields. The technical education produces technicians for all type of industries and it is true that the progress of a country much depend upon its Industrialization without which a handsome economy would not be possible. Using a technology is far easier than to develop it. For developing a technology, it needed high skill teams which have a high data for the theme. It also needed a high amount of time and also money. To fulfill all these, there must be technical institutes which must cover all the faculties of technological studies and also the support of government to support financially & to contruct it at international level. If it would be at International level then it would be easier to students to grab data in their own state so that they could do something for their own country. Pakistan leads in the technological era. The exhibition canters in Pakistan plays a vital role in backing up the technicians to come up with more and more new technologies because it gives reflection of our technologies to the foreigners which are representing their country, which means we are reflecting our image to that world. By this we have a sense of development and prosperity that we also produce creative mind in the technological aspect. As far as Pakistans implementation in techno field is concern, we might look around and observe that in every field of life we are using high class technologies whether it is in the Industrial purpose, business purpose, agriculture purpose or defensive purpose. There has been a lot of emergence of on-line trading, which deals with high technological concerns in term of machinery and software. Pakistan Telecommunication field also deal with high-class technology. Pakistan also promises to produce best technicians of its own through their technical education centers which allow approximately all the faculties for technical development. These institutes also support the new courses of technology which are introduced at a instant so that there would be no line at which we lay behind. The most important institutes of in Pakistan which support the technical courses incorporate, NED University, GIK University, Karachi University, Mehran University and there are also some other private Universities which deal in technological subjects. These institutes promise to produce technicians who cold meet the challenges of the technological era. I feel proud when I watch the students rushing towards these technical institutes to become a prosperous technician who have a sense of responsibility for the progress of their nation. Technical education promotes the material prosperity and economic advancement. It produces the sense of self-respect and dignity. If a country has her own technical experts, she may save a lot of foreign exchange i. e. Technical Education makes a country rich, prosperous and resourceful. Our country is rich in raw material resources but the thing is, we must have enough technical information to benefit from them.

Dating Younger Men Whats in It for You

Demi Moore, Madonna, Halle Berry, Mariah Carey, what do these names have in common aside from being famous? They have all dated significantly younger men. These women are always attending parties, events, red carpets, meeting millions of people, so what made them choose the young boy over so many attractive, interesting men around their age? They are â€Å"cougars† some people would say, a term referring to women dating younger man, that according to sex and relationships columnist and writer Valerie Gibson was originated in Vancouver, British Columbia, as â€Å"a put-down for older women who would go to bars and go home with whoever was left at the end of the night. † Twenty years ago this would have been looked at as strange and unusual, but it’s becoming more common every day. In 2003 a study by AARP revealed that 34 percent of all women over 40 in the survey were dating younger men, and 35 percent preferred it to dating older men. The most recent U. S. Census Bureau figures show that 12 percent of all marriages were between older women and younger men. What is all the craze about? What makes these young boys so appealing to older ladies? Some of the reasons why women enjoy dating younger men are the control they can exert over them, their sexual empathy, and the feeling of being younger. The first juicy little trait these women enjoy is having more control over their partner if he is younger than with a man at the same age. Older men are set in their ways of thinking, and because of past experiences, they have formed their character and personality and are not looking to change that. Young men are more willing to learn and being told what to do by their woman can give them a sense of stability and protection, which is also appealing for them. Some women have a motherly instinct that can be satisfied by dating someone younger, who they can take care of and at the same time tell them what to do. English writer Oliver James shares a thought in his article, â€Å"Why are so many older women into dating young men†: â€Å"They can use their wisdom to help their young men, while getting a lot back in return. Many young men also enjoy this feature of dating an older lady, which allows them to learn new things and be with a confident woman. (125) Furthermore, another important factor that these women are attracted to is the sensation of feeling young again. Dating a younger man can take them back to their college years and can even increase their ego and self image by realizing that they still attract the interest of a young man. This is the sensation these women experience while dating younger men; in the words of Dr. Jennifer Berman, urologist and expert in women’s sexual health, â€Å"feeling beautiful, feeling attractive, feeling young. Being appreciated as a woman for all that you are and all that you’ve learned and all that you’ve become. This fuels that high self esteem, making them even more attractive to their partner. Last but certainly not least, the compatibility under the sheets. Older women and younger men soon realize that they have something in common that makes the relationship so much better, their sex drive. Online column writer Chuck Ross, points out in his article, â€Å"The Sexual Peak Myth†, how â€Å"men hit their sexual peak at the age of 18 while women hit theirs at 30-35. † He further explains that â€Å"despite literally no scientific support for this theory, this has become â€Å"common knowledge† in our society. This makes complete sense, a women who is dating an older man, maybe in his 40’s or 50’s may have the same reading taste, enjoy listening to the same music and share their interest on visiting museums all over the world, but when it comes to the bedroom, they might be going in completely opposite directions. This issue is obviously non existent with young studs. Self proclaimed cougar and author of Hot Cougar Sex Llona Paris, shares her point of view: â€Å"Flirting with and bedding a hot younger guy can ignite a woman’s confidence. And attention from a beautiful older woman will stroke a man’s ego. A cougar knows what she wants, particularly in the bedroom. And because of her experience in the boudoir, she has a lot to share, which is interesting for younger men. † (78) Yvonne K. Fulright, a writer for Fox News website, on her article â€Å"Sink your teeth into the cougar†, reflects about how young men are aroused by their strong confidence, less inhibited personality and more mature sexuality than younger girls. This makes them look in control and secure about themselves, and they are not shy about sharing what the like in bed, and showing it to their young partners. This further analysis helps the reader understand even better, why young men are more than willing to experiment having a relationship with an older women. Its understandable why some women make this choice, being able to control their partner gives them a sense of security, the benefits of feeling forever young, and the excitement of a having a perfect match inside the bedroom. All this reasons can make a steady long lasting relationship between an older women and a younger man, contrary to what was believed years ago, a successful relationship doesn’t have to be composed of an older more experienced man and a younger wome