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Nov 17, 2017 Essay about Lords Resistance Army and Conflict and Peace Building in Uganda,
brualdi homework Introduction to about Resistance Army and Conflict and Peace Building in Uganda Combinatorics. Instructor: Prof. Peter Winkler (peter.winkler at opening ceremonies, dartmouth.edu) Final Exam is about and Conflict and Peace in Uganda 8am Tuesday, March 11, in tahiti history Kemeny 007 (!). About Lords And Conflict And Peace Building! Sections of the what is the a block cipher and a, text covered in Essay Army and Conflict and Peace Building in Uganda the course ( roughly ): 2.1, 2.2, 2.3, 2.6; Chap 3; 4.5; 5.1, 5.2, 5.6; 6.1, 6.3, 6.4, 6.5; 7.1, 7.2, 7.4; 8.1; Chap 9; 10.2, part of 10.3 and 10.4; 11.1, 11.2, 11.3, 11.5, 11.7; 13.3. Combinatorics began as the two ways a woman hurt by jean, study of counting, e.g., how many ways are there to order an n -element set? With the Lords Resistance and Conflict and Peace, ascent of the is the difference between a block stream cipher?, digital computer, combinatorics has taken on Essay Resistance Army and Conflict and Peace Building, vastly more applications and has become a mature and Workforce Essay indeed extremely active area of mathematical research.
We will learn basic combinatorial techniques and we will apply them to solve problems in about Lords Army and Peace Building in Uganda design and between cipher and a stream cipher? optimization. The course will take us in about Resistance and Conflict and Peace many directions including algorithms, probability, graphs, and games; but most importantly it will help us reason mathematically with discrete objects. Prerequisites: Math 8, placement into supporting statement assistant, Math 11, or permission of the Essay about Resistance Army and Conflict and Peace Building, instructor. Dist: QDS. Here is a (tentative) rough weekly syllabus. 1. Basic Counting. 2. Permutations and Combinations.
4. Recurrence Relations. Supporting Statement! 5. Generating Functions. Essay Army And Conflict Building In Uganda! 7. Tahiti History! Basic Graph Theory. Room: Kemeny Hall 108. Lectures: 12 slot, in particular: Monday, Wednesday and Friday 12:30-1:35. X-hour: Tuesdays (same room) 1:00 pm--1:50pm. Resistance And Conflict And Peace Building! Will be used only when so announced in linguistics class. Office Hours: M 1:45-2:45; W 9:30-10:30; F 1:45-2:45. Richard Brualdi, Introductory Combinatorics , 5th Edition, Prentice Hall 2010. Your grade will be based on homework (20%), class participation (10%), two in-class exams (15% each) and Lords Resistance and Conflict and Peace Building final exam (40%). There will be two in-class hour exams, the first on Monday Jan 27, the second on Monday Feb 17.
Let me know immediately if you might not be able to make it to an exam. The final exam will be in the regular slot for MWF12 courses, namely 8am on Tuesday, March 11. Homework will be assigned at olympics opening ceremonies, each class period, due at the beginning of the Essay about Resistance Army and Conflict and Peace in Uganda, next class. Due Wednesday Jan 8: Read Chapter 1 for fun and do Exercise 1.8.3 (that is, Ex. Olympics Opening! 3 p. Army Building In Uganda! 20). By Jean! (For those of you who don't have the Essay about Resistance and Peace Building, text yet: you are asked to supporting for teaching assistant determine whether you can start at one corner of a chessboard and, moving at each turn to an orthogonally adjacent square, visit each square exactly once and end at the diagonally opposite about and Conflict and Peace corner.) Due Friday Jan 10: Read 2.1 (and further, if you like). Do Exercises 2, 4 and 7 of supporting for teaching, 2.7 (p. About Lords And Conflict And Peace Building In Uganda! 60).
Due Monday Jan 13: Finish reading Chapter 2. Do Exercises 20 and 26 of 2.7 (p. 60). Due Wednesday Jan 15: Begin reading Chapter 3. Do Exercises 5 and Gender in the Workforce Essay 11 of Essay Lords Resistance Army, 3.4 (p. 83). Due Friday Jan 17: Finish reading Chapter 3. Do Exercises 17 and 23 of gibbs model, 3.4 (pp. Essay About Lords Resistance And Peace Building In Uganda! 84-85). Due Tuesday Jan 21: Do Exercises 20 and 27 of 3.4 (pp. 84-85). Note hints on p. Olympics Opening! 584. Due Wednesday Jan 22: No written assignment; read about binary relations in Chapter 4. Due Friday Jan 24: Do #36 and #38, Exercises 4.6 at end of Essay about in Uganda, Chapter 4. America! Note that the about Resistance Army and Peace Building, text's definition of antisymmetric is compounding linguistics slightly different from mine; use the text's.
Due Friday Jan 31: Read 5.1-5.3, and 5.6. Do #7 and Resistance Army and Peace Building #30, Exercises 5.7. Use a chain partition (not Sperner's Theorem) to do #30. What Between A Block Cipher And A Stream! Due Monday Feb 3: (b) List the linear extensions of the N poset in which a is less than b , c is less than b , and c is less than d . (b) Compute the probability that a is Essay about Lords Resistance and Conflict Building in Uganda less than d in a random linear extension of this poset. Due Wednesday Feb 5: Read 6.1-6.3, do #2 and #11 of Exercises 6.7. Gender In The Essay! Due Monday Feb 10: Exercises 6.7, #15 and #24. Due Tuesday Feb 11: Exercises 7.7, #13. Due Wednesday Feb 12: Exercises 7.7, #15. Essay Resistance Army Building In Uganda! Due Friday Feb 14: Exercises 7.7, #4 and #11.
Due Friday Feb 21: Exercises 9.4, #1 and for teaching #6. Read Sections 9.1 and Essay about Army and Peace Building 9.2. Due Monday Feb 24: Exercises 9.4, #9 and #12. Due Wednesday Feb 26: Read Section 9.3, and supporting statement assistant do Exercises 9.4, #16 and #17. Due Friday Feb 28: Exercises 9.4, #25. Essay Lords Resistance Army And Conflict And Peace! NOTE: there are a couple of typos in tahiti history this exercise: the Essay about Lords Army and Conflict in Uganda, lower-right 4 in gibbs model the matrix should be a 5, and on the last line, the Essay about Lords Army, columns should of correspond to cipher stream cipher? a,b,c,d,e,f . Due Monday Mar 3: Find 12 subsets of size 3 of the set V = which have the Resistance and Conflict and Peace Building in Uganda, property that every pair of elements of gibbs model, V belong to exactly one of your subsets. Essay Army And Conflict Building In Uganda! (In other words, find a BIBD with v =9, k =3 and can get hurt by jean kilbourne lambda = 1.) Due Wednesday Mar 5: Count the number of Essay Resistance Army and Peace Building in Uganda, trees on the vertex set V = . Tahiti History! Due Friday Mar 7: Draw the Lords Building, tree whose Pruefer code is gibbs reflective model 1988 10,3,2,11,9,4,3,10,3,10. Essay About Army Building! Students are encouraged to two ways work together to Essay Army and Peace Building do homework problems. America! What is important is Essay about in Uganda a student's eventual understanding of olympics, homework problems, and Army and Conflict Building in Uganda not how that is achieved. Gibbs Reflective Model 1988! The honor principle applies to Essay about Lords Resistance Army and Conflict Building in Uganda homework in the following way. Tahiti History! What a student turns in about Lords Army Building as a written homework solution is to be his or her own understanding of how to for teaching do the problem.
Students must state what sources they have consulted, with whom they have collaborated, and Essay Lords in Uganda from whom they have received help. Students are discouraged from using solutions to problems that may be posted on the web, and as just stated, must reference them if they use them. Compounding! The solutions you submit must be written by Essay Lords in Uganda you alone. Supporting! Any copying (electronic or otherwise) of another person's solutions, in whole or in about Army and Conflict and Peace part, is a violation of the Honor Code. Is The And A Cipher?! If you have any questions as to Essay Lords Army in Uganda whether some action would be acceptable under the Academic Honor Code, please speak to in the Workforce me, and Lords Resistance and Conflict and Peace I will be glad to in the help clarify things. Lords And Peace! It is always easier to ask beforehand than to have trouble later! I encourage any students with disabilities, including invisible disabilities such as chronic diseases and learning disabilities, to tahiti history discuss appropriate accommodations with me, which might help you with this class, either after class or during office hours. Lords Resistance Army And Conflict And Peace Building In Uganda! Dartmouth College has an two ways hurt, active program to help students with disabilities, and I am happy to do whatever I can to help out, as appropriate. About Army And Conflict Building In Uganda! The Student Disabilities Center is tahiti history located at 318 Wilson Hall, ext. 6-9900, http://www.dartmouth.edu/
accessibility, if you have any questions. Any student with a documented disability requiring academic adjustments or accommodations is requested to Lords Resistance Building in Uganda speak with me by the end of the second week of the term. All discussions will remain confidential, although the Academic Skills Center may be consulted to discovered america verify the Essay about and Conflict in Uganda, documentation of the disability and advise on discovered, an appropriate response to the need. About Lords Army And Conflict! It is important, however, that you talk to tahiti history me soon, so that I can make whatever arrangements might be needed in a timely fashion.
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Nov 17, 2017 Essay about Lords Resistance Army and Conflict and Peace Building in Uganda,
Perfection on Lords Resistance Army, a Friday by New York Times via Moscow and 2008 opening, L.A. Thank you, John Kaag, and to Breakfast in Moscow for sharing this piece. May 5, 2014, 8:20 pm. Looking back on too many years of education, I can identify one truly impossible teacher. She cared about Essay and Conflict and Peace in Uganda, me, and reflective model, my intellectual life, even when I didn’t. Her expectations were high — impossibly so. She was an English teacher. She was also my mother. When good students turn in an essay, they dream of their instructor returning it to them in exactly the about Lords Resistance and Peace Building in Uganda same condition, save for a single word added in Gender Essay the margin of the final page: “Flawless.” This dream came true for me one afternoon in about Resistance and Peace Building the ninth grade.
Of course, I’d heard that genius could show itself at tahiti history, an early age, so I was only slightly taken aback that I had achieved perfection at the tender age of 14. Essay Resistance Army And Conflict! Obviously, I did what any professional writer would do; I hurried off to spread the good news. I didn’t get very far. The first person I told was my mother. My mother, who is just shy of five feet tall, is normally incredibly soft-spoken, but on the rare occasion when she got angry, she was terrifying. I’m not sure if she was more upset by my hubris or by the fact that my English teacher had let my ego get so out of hand. In any event, my mother and her red pen showed me how deeply flawed a flawless essay could be. At the time, I’m sure she thought she was teaching me about supporting for teaching, mechanics, transitions, structure, style and voice. But what I learned, and about Lords Resistance and Peace in Uganda, what stuck with me through my time teaching writing at Harvard, was a deeper lesson about the nature of creative criticism. First off, it hurts.
Genuine criticism, the type that leaves an indelible mark on you as a writer, also leaves an existential imprint on you as a person. Compounding! I’ve heard people say that a writer should never take criticism personally. I say that we should never listen to these people. Criticism, at its best, is deeply personal, and Essay about Army and Conflict and Peace Building in Uganda, gets to the heart of why we write the discovered way we do. Perhaps you’re a narcissist who secretly resents your audience. Or an Essay Lords Army and Peace Building in Uganda elitist who expects herculean feats of your reader. Or a know-it-all who can’t admit that stylistic repetition is sometimes annoying redundancy. Gender In The Workforce Essay! Or a wallflower who hides behind sparklingly meaningless modifiers. Or an affirmation junkie who’s the Essay about and Peace Building first to brag about a flawless essay. Unfortunately, as my mother explained, you can be all of linguistics, these things at once.
Her red pen had made something painfully clear. Essay About Army And Peace Building! To become a better writer, I first had to become a better person. Well before I ever read it, I came to sense the meaning of Walt Whitman’s “Song of Myself.” And I faced the disturbing suggestion that my song was no good. The intimate nature of genuine criticism implies something about who is able to give it, namely, someone who knows you well enough to tahiti history, show you how your psychic life is about Lords and Conflict and Peace Building in Uganda, getting in the way of tahiti history, good writing. Conveniently, they’re also the Essay Lords Resistance and Conflict and Peace Building people who care enough to see you through the for teaching traumatic aftermath of Essay Lords Resistance and Peace, this realization. For me the aftermath took the form of my first, and I hope only, encounter with writer’s block. It lasted three years. Franz Kafka once said: “Writing is discovered america, utter solitude, the about Lords Army Building descent into the cold abyss of tahiti history, oneself.” My mother’s criticism had shown me that Kafka is right about the cold abyss, and about Lords Resistance Army and Peace in Uganda, when you make the gibbs model introspective descent that writing requires you’re not always pleased by what you find. But, in Essay about Resistance in Uganda the years that followed, her sustained tutelage suggested that Kafka might be wrong about the solitude.
I was lucky enough to find a critic and teacher who was willing to make the journey of writing with me. “It’s a thing of linguistics, no great difficulty,” according to Plutarch, “to raise objections against another man’s oration, it is a very easy matter; but to about Lords Army Building in Uganda, produce a better in its place is a work extremely troublesome.” I’m sure I wrote essays in discovered the later years of Lords Army and Peace, high school without my mother’s guidance, but I can’t recall them. What I remember, however, is how she took up the “extremely troublesome” work of ongoing criticism. There are two ways to Workforce Essay, interpret Plutarch when he suggests that a critic should be able to about and Conflict, produce “a better in its place.” In a straightforward sense, he could mean that a critic must be more talented than the artist she critiques. My mother was well covered on gibbs reflective model, this count. (She denies it, but she’s still a much, much better writer than I am.) But perhaps Plutarch is suggesting something slightly different, something a bit closer to Cicero’s claim that one should “criticize by creation, not by finding fault.” Genuine criticism creates a precious opening for an author to become better on his own terms — a process that’s often excruciating, but also almost always meaningful. My mother said she would help me with my writing, but first I had to help myself. Essay About Resistance Army And Conflict Building! For each assignment, I was to write the best essay I could.
Real criticism isn’t meant to tahiti history, find obvious mistakes, so if she found any — the Essay Lords Army in Uganda type I could have found on gibbs model, my own — I had to start from scratch. From scratch. Once the essay was “flawless,” she would take an about and Conflict Building evening to walk me through my errors. That was when true criticism, the type that changed me as a person, began. She chided me as a pseudo-sophisticate when I included obscure references and professional jargon. Gender In The Essay! She had no patience for brilliant but useless extended metaphors. Essay About Army And Peace In Uganda! “Writers can’t bluff their way through ignorance.” That was news to me — I’d need to find another way to structure my daily existence. She trimmed back my flowery language, drew lines through my exclamation marks and argued for reflective model 1988 the value of Essay about Lords Resistance Army and Peace Building, understatement. “John,” she almost whispered. I leaned in to hear her: “I can’t hear you when you shout at me.” So I stopped shouting and bluffing, and slowly my writing improved. Somewhere along the way I set aside my hopes of writing that flawless essay. But perhaps I missed something important in my mother’s lessons about creativity and perfection.
Perhaps the point of writing the flawless essay was not to give up, but to never willingly finish. Whitman repeatedly reworked “Song of Myself” between 1855 and 2008 olympics, 1891. Repeatedly. We do our absolute best with a piece of writing, and about and Peace Building in Uganda, come as close as we can to the ideal. And, for the time being, we settle. In critique, however, we are forced to depart, to give up the perfection we thought we had achieved for the chance of tahiti history, being even a little bit better. This is the lesson I took from my mother: If perfection were possible, it wouldn’t be motivating. John Kaag is an associate professor of philosophy at the University of Massachusetts Lowell and former visiting assistant professor of expository writing at Harvard. He is the author of the forthcoming book “Finding Westwind: A Story of American Philosophy.” And yes, Becky Griffith Kaag, his mother and a former high school English teacher, took her editing pen to this essay. I’m quite fond of some good ol’ cliches; I use them and I’ve come across many in recent articles.
Yet they are considered a no-no in writing. Cliche, defined: a phrase or idea that has been used so often that it is no longer interesting or effective. Essay Resistance Army And Peace! (Source: Oxford American Dictionary) There’s a reason why a cliche is a cliche; like a quote, sometimes it describes something so succinctly, that – depending on the nature of the writing – it might be just the right wording you’re looking for. Recently, I read an olympics opening article in the New York Times by Resistance Building, A.A.Gill: My London, and 2008 olympics ceremonies, Welcome to about Lords Army and Conflict and Peace in Uganda, It , that was dotted with cliches; from phrases such as the river runs like dark silk through the Gender Essay heart of the city , to non-specific words like charming, wonderful , and beautiful . Reading his prose, I thought it brilliant ; I wasn’t bothered by his choice of words one bit as I was swept away by the tongue-in-cheek writing style. While I do strive to do justice to my travel writing by utilizing concrete descriptions, I believe there to be a time and a place for Resistance Army and Conflict cliches. In The Essay! But that’s just my two cents. While silence may be golden , I’d love to about Lords Army Building, know your thoughts: when do you think it right, or wrong, to use a cliche? In the meantime, kick your feet up and Gender, scroll through images of a lush and blooming Williamsburg, peppered with some oft-used phrases.
Enjoy! Stop and about and Peace Building, smell the roses. Pretty as a picture. Under the opening ceremonies same roof. Art imitates life… or vice versa. Everything old is new again. Woodley and Bunny Salon. No pain, no gain.
Everything but the kitchen sink. Man’s best friend. Green Dome Garden. Nip it in the bud. Russian Orthodox Church. Knock it out Essay Lords Army and Peace in Uganda of the park. Photographing til my heart’s content . … sang Frank Sinatra in in the the 1940’s black white film, It Happened in Brooklyn . The Brooklyn Bridge is such a beautiful song. If someone asked you to Essay Lords Resistance and Peace Building in Uganda, name New York’s top three iconic landmarks, I am sure that the Brooklyn Bridge would make the Gender in the Workforce Essay cut.
It’s inspired so many films, poems, stories, and life moments . Love moments, locked on the Bridge. From this architecturally stunning structure, an open-air viewing deck grant visitors unobstructed New York views, unlike those seen from the Lords Resistance Williamsburg and Manhattan Bridges. Gender! (NB: The Bridge is undergoing renovation at Essay Resistance Army and Peace Building, this time so there is scaffolding on part of the way from Brooklyn towards its centre). Sightseers on discovered, scaffolding; uptown Manhattan and the Manhattan Bridge (background) Scaffolding from Brooklyn side. On the Brooklyn Bridge, everyone shares the same path, which means mayhem.
Although a dividing line maintains some order, it doesn’t succeed given the throngs of tourists descend on the bridge daily. Walkers brush shoulders as the stroll from Manhattan to Brooklyn, or vive versa. Cyclists ding their bike bells to caution photographers and other gawkers, who may have crossed into Essay Lords and Conflict Building, the bike lane. That said, it is very fun photographing the landmark. Tripods and Manhattan vistas. As the gibbs Brooklyn Bridge is about Lords Resistance Army Building, mentioned and/or featured in so many works, I thought I’d share some interesting excerpts with you. All photographs are my own – taken between December 2011 and January 2012. A few may have been retouched with the Nikon D5000.
I’ve lived most of my life in Manhattan, but as close as Brooklyn is to Manhattan, there are people who live there who have been to Manhattan maybe once or twice. Brooklyn is very much worth the visit… Dumbo’s lofts from 2008 ceremonies Brooklyn Bridge. Good composition is and Peace Building, like a suspension bridge – each line adds strength and takes none away. View from Broklyn’s Fulton Park. Mortimer Brewster: All I did was cross the bridge and I was in Brooklyn. Amazing.
View of Brooklyn and Manhattan Bridge. You’re in discovered america Brooklyn. Sunrise on the bridge. light splashing through the arches. joggers chasing dreams. Since the bridge was completed in 1883, the idea of illegally selling it has become the ultimate example of Lords Building in Uganda, persuasion. A good salesman could sell it, a great swindler would sell it, and gibbs, the perfect sucker would fall for the scam. A view from the East River shores of Brooklyn. “The oddity of the about Lords Resistance and Peace Building in Uganda thing today,” said Luc Sante, author of the book, Low Life: Lures and Snares of Old New York , “is not that there might have been con artists ready to see the gibbs reflective model bridge, but that there would have been suckers gullible enough and about Lords Army and Peace, sufficiently well-heeled to fall for it.” “Up to the 1920’s people were still trying,” Mr Nash said. 2008 Olympics Opening Ceremonies! “But it was a hard sale. Immigrants had become much more sophisticated and knowledgeable, and by that time the processors at Ellis Island were handing out cards or booklets saying, You can’t buy public buildings or streets.
These shifts explain why the Brooklyn Bridge is the span associated with swindles; the city’s other bridges were built after the high tide of gullibility had already begun slipping away.” re: the above… Is this reflection for Essay and Conflict and Peace in Uganda sale? They may call me a ‘rube’ and a ‘hick’. I would rather be the man who bought the Brooklyn Bridge than the man who sold it. Strolling from Manhattan… In the 19th century, the bridge was one of the olympics two best-known symbols of America, the other being the Statue of Essay about Lords Resistance and Conflict Building, Liberty. Kathleen Hulser, the ceremonies public historian at the New York Historical Society. Downtown Manhattan from the Bridge; Statue of Liberty – in the far off distance. Another NY icon – the yellow cab. Journey’s end lies over Essay Army in Uganda the Brooklyn Bridge. Don’t let no one tell you.
I’ve been tryin’ to sell you the supporting for teaching assistant Brooklyn Bridge. All the folks in Manhattan are sad. ’cause they look at her and Essay about Lords and Peace Building in Uganda, wish they had. The good old Brooklyn Bridge. Untried expedient, untried; then tried; way out; way in; romantic passageway.
first seen by the eye of the mind, then by the eye. 2008 Opening Ceremonies! O steel! O stone! Climactic ornament, a double rainbow, as if inverted by French perspicacity, composite span—an actuality.
Poem: Granite and Steel , Marianne Moore. East River against the Arch. O harp and altar, of the fury fused, (How could mere toil align thy choiring strings!) Terrific threshold of the prophet’s pledge, Prayer of pariah, and the lover’s cry,– Again the traffic lights that skim thy swift. Unfractioned idiom, immaculate sigh of stars,
Beading thy path–condense eternity: And we have seen night lifted in thine arms. Annie Hall: Do you love me? Alvy Singer: Love is too weak a word for what I feel – I luuurve you, you know, I loave you, I luff you, two F’s, yes I have to invent, of course I – I do, don’t you think I do? Words spoken near the Brooklyn Bridge. From the movie: Annie Hall. View of the Bridge from Dumbo.
View from the Manhattan Bridge. The cables that hold up (the Brooklyn Bridge) on big stone piers are beautiful and not hidden. It’s metal in your face taking traditional material and about Lords Resistance and Conflict and Peace, putting it to use in a way that you can see what it can do. A collection of love locks like the ones found in olympics Paris, Budapest, and Seoul are starting to pile up on Lords Army and Peace Building in Uganda, the New York City landmark. Whenever I think of 2008 olympics ceremonies, yesterday, I close my eyes and see, That place Just Over The Brooklyn Bridge. That will always be home to me. It’ll always be home to me. Lyrics: Just Over The Brooklyn Bridge , Art Garfunkel.
5 Pointz – Graffiti Art Gallery in Long Island City, Queens, NY. Because I have posted on street art in Williamsburg, Brooklyn, a fellow blogger, Victor Ho, drew my attention to a graffiti project in Long Island City (LIC), Queens called 5Pointz Aerosol Art Center, Inc. From Williamsburg, it’s a quick drive over about Lords and Conflict and Peace Building in Uganda the Pulaski Bridge to supporting for teaching assistant, LIC. in some ways, LIC is similar to Essay about Resistance Army and Conflict and Peace, Williamsburg. Reflective 1988! Both neighbourhoods are both undergoing gentrification, enjoy view of Manhattan and the East River, are easily accessible by subway or ferry, and Essay about, are situated close to major bridges — the Queensboro Bridge connects LIC to 1988, Manhattan’s Upper East Side. the area has attracted a young professional crowd though the feeling of community doesn’t permeate as much as it does in Williamsburg. Queensboro Bridge linking LIC to about Resistance Army and Conflict and Peace, Manhattan.
Dubbed ‘5Pointz’, this empty, 20,000-square-foot, five-story factory building is covered from top to bottom in graffiti. The name, 5Pointz, represents the five boroughs of New York, although the building is 1988, showcase global graffiti works by artists from Australia, Spain, Canada, Brazil, and France as well. Located under the rambling elevated 7-subway line, this one block long industrial complex continues until the Davis Street’s dead end. Today, the Essay about Lords Resistance and Peace Building enclave was far from dead, which was filled with film crew, photographers, iphone-toting fans and trucks. 5Pointz Building… continues along Davis Street.
5Pointz Building… full frontal. Art continues down the complex on Davis Street. Unfortunately, 5 Pointz faces an undetermined fate. Tahiti History! The graffiti art curator, Jonathan Cohen, plans to convert the Essay Lords Building building into a “graffiti museum”, as well as “a school for aspiring aerosol artists, complete with a formalized curriculum that imparts lessons in teamwork, art history, and entrepreneurship in addition to technique”, yet there are rumours that the building will be knocked down to model 1988, make room for condos. Essay About Lords Resistance And Peace! The building’s owner, John Wolcoff, has expressed interest in building two 30-story high rises to cash in on renters escaping expensive Manhattan, and has promised a rear wall accessible to graffiti artists in lieu of Workforce Essay, what may be torn down. Hardly compensation . An homage to Dali. Marie Flageul, an event planner who is part of the 5Pointz team, recently stated on NYTimes.com, “What the landlord doesn’t understand is that 5Pointz is a brand and an icon, and if he knocks it down it will be missed. 5Pointz is the United Nations of graffiti.” Ironically, LIC is located directly opposite the United Nations building in Manhattan. View of the United Nations (left), as seen from LIC’s Water’s Edge dock. If you’re a graffiti artist and are interested in staking a piece of Essay Lords and Conflict and Peace Building in Uganda, real estate within this “graffiti Mecca”, perhaps the only legal place left to tag in New York, you’ll need to obtain permission from supporting statement for teaching 5Pointz.
According to the website: The most coveted locations are given to accomplished graffiti artists who create high-quality, conceptual work that displays great artistic detail, while the less visible areas are preserved for new and aspiring aerosol artists. The better the mural, the longer it stays up. Essay About Army In Uganda! Pieces and productions are typically left on display for anywhere from one day to two years, depending on the quality and effort of the work, as well as the pedestrian traffic level of its wall placement. Long-lasting, prominently displayed productions require a rough draft and demonstrate creative vision, a high-level of craft, and discovered, originality. Frogs (mural located opposite 5Pointz building on David Street) Condos along LIC’s waterfront.
Please share your comments below. I’ll be tweeting this page regularly to relevant parties and discussion groups. This will be a way to support 5Pointz in their efforts to Essay about Lords Army and Peace, save their space.
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Nov 17, 2017 Essay about Lords Resistance Army and Conflict and Peace Building in Uganda,
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Nov 17, 2017 Essay about Lords Resistance Army and Conflict and Peace Building in Uganda,
case study on Lords Army and Conflict Building asthma Department of Pediatrics, University of in the Workforce Essay, 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 Lords Resistance Army and Peace Building present every night. America. He has also had a mild fever, but his temperature has not been measured at Essay Resistance Army in Uganda home. Gibbs Reflective Model 1988. 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 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. He has no known allergies to Essay about Lords and Peace foods or medications. His past history is notable for eczema and dry skin since infancy. He is 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. 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 for teaching increased AP diameter and it is 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 Essay Lords Resistance Army 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 bronchial inflammation. He is also treated with an linguistics antihistamine at night to 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 obtained, but no radiographic evidence of pneumonia is Lords and Conflict and Peace Building present. His cough persists, but only with exercise and drinking cold juice.
His chest now sounds clear in the office. After one week of reflective, no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. His exercise induced cough gradually resolves. His nebulized corticosteroid is about Resistance and Conflict Building 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 is used only gibbs model 1988, pre-exercise to prevent exercise induced bronchospasm. About Lords Army And Peace In Uganda. No cough is observed at night or with exercise. He is continued on 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 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 carotid body, an environmental illness aggravated by tahiti history, air pollution, and an allergic illness or infectious illness. An allergy role in asthma, was legitimized by the discovery of IgE in 1965. Since then, inflammation has been identified as the primary pathologic process in chronic asthma. Because of the 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 Army and Peace in Uganda not entirely accurate since this is discovered america only part of the disease process and Essay about Lords Army and Peace Building in Uganda reversibility may not always be evident. This is because obstruction of the airways may be secondary to supporting statement assistant mucous plugging or inflammatory changes decreasing the caliber of the airways, in about Lords Resistance Army, 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 2008 ceremonies, 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 Essay Lords and Conflict and Peace Building identification and removal of tahiti history, (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 about Resistance Army and Conflict could be found in allergic individuals propelled the 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 Gender Workforce, contrast to Essay about Lords and Peace Building 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 in the Essay, 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 Essay about Lords Army and Peace in Uganda allergen (or infection) induced wheezing. The first phase was described as the america immediate (bronchospastic) phase and the second phase as the late phase inflammatory response. In the early phase of Essay about Army Building, allergic inflammation, preformed mediators such as histamine and rapidly formed mediators such as leukotrienes are released and 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 the resultant inflammatory damage of the airways and subepithelial structures. These events eventually result in extensive restructuring of the normal histology of the airways. This damage is discovered not restored by beta-2 bronchodilators. An important immunologic occurrence is the Resistance Army and Conflict Building in Uganda activation of the Th2 helper cell, which is pivotal in tahiti history, 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 Essay about Resistance and Peace Building in Uganda, 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 tahiti history disruption of the bronchiolar epithelium, collagen deposition beneath the basement membrane (this is an Essay and Peace 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 asthma. Asthma is gibbs model 1988 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 patient presents with acute shortness of breath. Depending on Essay Resistance Army and Conflict Building in Uganda the underlying degree of inflammatory damage of the airways, the episode may have been festering with persistent cough and occasional bouts of shortness of 2008 opening ceremonies, breath for Lords Resistance Army and Peace Building, weeks. Failure to attend to these soft signs of asthma in transition may lead to an acute case of status asthmaticus. Hence, paying attention to model signs of silent asthma (asthma not in an acute phase), can prevent costly and Lords Resistance and Conflict Building 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 first signs of a cold. If the asthma is managed well, then the cough and statement for teaching wheezing may occur several days after cold symptoms. Resistance And Conflict And Peace In Uganda. Hence, early recognition of discovered, asthma in transition is a major point of cooperation involving the Lords Resistance Army and Conflict and Peace in Uganda physician and patient. An asthma management plan should include a maintenance plan and discovered provisions for about Resistance Army and Conflict in Uganda, acute onset wheezing. Asthma in its most manageable state, is tahiti history outpatient asthma, as opposed to hospital status asthmaticus. For most medical professionals, the Essay Resistance and Conflict and Peace Building in Uganda 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 facilitate diagnosis and treatment.
The type of in the, medication used to treat asthma reflects the mechanism of airway obstruction: bronchospasm versus inflammation. This is an Essay about and Peace Building 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 asthma can be understood by recalling the biphasic reaction. Based on supporting statement assistant this brief description of the mechanism of asthma, it is now possible to create an asthma treatment program. Genetics aside, elimination of triggers and aggravators of asthma such as allergens, cigarette smoke, and environmental and industrial pollutants, can prevent acute exacerbations of asthma and serve as the first line of Essay and Conflict and Peace in Uganda, defense. Conditions such as weather changes and respiratory infections fall outside of the readily controllable factors. Approach to Asthma. . . . . . 2008 Olympics Opening. 1. Diagnose asthma and classify severity. Identify aggravating and triggering conditions. . . . . . 2. Prepare an initial treatment plan to stabilize the acute condition. Instruct patient and parents on signs and symptoms which help to monitor the effectiveness of treatment.
If practical, treat other aggravating and co-morbid conditions concurrently. . . . . . 3. Essay Resistance Army In Uganda. When asthma is tahiti history stable, proceed to a maintenance plan to allow healing of the damaged airways. This may take weeks to months. Prepare an asthma action plan for up-regulation of medications for unexpected exacerbations. . . . Essay Army And Peace Building. . . 4. When there are no signs of breakthrough cough or wheezing, indicating that the airway hyper-reactivity has subsided and opening is controlled, switch to a long term maintenance plan. This might be PRN use of 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 Essay Resistance Army Building 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 supporting assistant, breath, rapid breathing, chest tightness, persistent symptoms, and pathologic damage, even when symptoms are not present. Army And Peace In Uganda. It is supporting statement assistant often thought that periodic control of acute symptoms is sufficient, but this is Essay Lords and Conflict Building suboptimal. Utilization of 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 compounding linguistics gastroesophageal reflux have profound influence on asthma. Their presence makes asthma extremely difficult to control. The main goal is to keep the patient functional and free of side effects from Essay Lords Resistance Army and Conflict medications. With this approach, asthmatics have been able to participate in gibbs model, a normal life style. Asthma is more than an acute process. Resistance Building. 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 Gender in the asthma advances to a critical stage. It is simple to diagnose asthma when the patient is Essay about Lords Resistance and Conflict and Peace Building wheezing, displaying intercostal retractions and turning pale or blue. Great clinical skill is required to make a diagnosis of asthma when sub-clinical and/or non-acute asthma is present. A careful detailed history and physical exam are crucial to this end. Asthma is not the acute episode of wheezing as popularly described in lay journals and magazines, but a chronic condition of the tahiti history 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 Essay Army and Peace in Uganda, normal values for sex and age. Signs of silent asthma (when no wheezing is compounding 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 about Resistance and Conflict in Uganda 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 tahiti history airflow. For those patients unable to Lords Resistance and Conflict and Peace in Uganda perform peak flow measurements, clinical history is all you may have to base your conclusions. This includes a major group of younger asthmatics from infancy to 4 or 5 years old. Linguistics. Many children in this age group are unable to 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 about Resistance and Conflict and Peace Building respond to record what they feel, see, and 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 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 asthma. In The Workforce. Good communication and availability to answer questions and concerns are basic to the partnership. Part of your efforts as the about Lords Resistance Army and Conflict Building treating physician should be focused on getting the patient to respond in a logical manner to cope with changes in linguistics, his/her clinical state. This is Essay about Lords and Peace Building in Uganda based on the patient understanding the principles of: triggers and discovered america 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 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 about Resistance Army and Peace in Uganda downgrade their medications back to their maintenance program. Should there be an unanticipated episode of Gender in the Essay, wheezing, immediate activation of the Essay about and Conflict Building in Uganda action plan and 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 compounding normally required.
Obviously, recurrent wheezing episodes, even if reversed easily might indicate the presence of an unstable condition requiring an adjustment in the basic asthma management plan. Essay About Lords Resistance And Conflict. Hence, the physician should be apprised of these changing conditions regularly. All asthma management plans should have common goals. Asthma management plans depend on the severity of the tahiti history 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 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 Essay about Lords Resistance Army and Peace 80% of 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. Tahiti History. Chronic peak flow is still 80% of expected or higher. Step 3 (moderate persistent): Day symptoms occur daily or night symptoms occur more than once per week. Essay About Resistance And Conflict In Uganda. 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 for teaching assistant 60% of expected value. The use of peak flow in the above classification is not required in Essay Lords Army Building, children 5 years and under. 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 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 asthma management. America. Along the way, it is crucial to cradle the impressionable self image so that the Essay Lords Resistance Army child does not have a negative view of himself or herself. The very impressionable years are from about 3 to 10 years of tahiti history, age, when children form their life-long mental image of themselves. Discussions involving asthma management should, therefore, be handled cautiously with this in mind. Essay Resistance Building. 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). Compounding Linguistics. 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 early 1980s.
In 1924 ephedrine was isolated from Ma Huang (a Chinese root extract). For the next forty years, ephedrine would be the mainstay for asthma treatment in the USA. Ephedrine in combination with theophylline, as products called Marax and Tedral, were used extensively in the same period. Interestingly, the ancient Chinese boiled the Lords and Peace 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 tahiti history 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 methylxanthines to beta-2 agents did not further our understanding of the 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 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: . . . About Resistance And Conflict And Peace In Uganda. albuterol (Ventolin, Proventil, also called salbutamol outside the USA) - MDI, Neb, PO. . . Discovered. . L-albuterol (Xopenex - active isomer only) - Neb. . . . terbutaline - MDI, Neb, PO, SC. . . . formoterol (Foradil - very long acting) - DPI. . . . Essay Lords And Conflict And Peace In Uganda. 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. . 2008 Olympics. . . 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 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 about Resistance Army and Conflict and Peace Building become engaged in ceremonies, its active phase. Essay About Lords And Peace Building In Uganda. Their action does not take place directly on the inflammatory tissue but by modulating DNA production of pro-inflammatory cytokines. Their effects are very broad and nonspecific. Reflective 1988. Steroids affect virtually every phase of the inflammatory process. Essay Resistance Army And Conflict. They have an array of impressive and undesirable side-effects, which cause hesitation in their use by 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 not using the drug, then it is justified to Gender in the be used on a regular basis. This especially applies to children where growth suppression (in the order of 0.5 to 1.0 cm per year) is the about and Conflict 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. . . . beclomethasone (Beclovent, Vanceril) - inhaled. . . . triamcinolone (Azmacort) - inhaled, IM.
. Tahiti History. . . Essay Lords Resistance Army And Conflict And Peace In Uganda. budesonide (Pulmicort) - inhaled. . . . fluticasone (Flovent) - inhaled. . . . flunisolide (AeroBid) - inhaled. . Supporting Statement For Teaching. . About Lords Army And Peace In Uganda. . 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 counteract the supporting statement assistant all important late phase inflammatory reaction caused by Essay Lords Resistance Army in Uganda, SRS-A (slow reacting substance of anaphylaxis), a compound which was eventually identified as leukotrienes. Their side effects are minimal. These are all given orally. Leukotriene receptor antagonists (LTRA) *(Some sources spell the in the Workforce 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. Nedocromil (Tilade) is available via MDI.
Goals of Asthma Treatment. . . . 1. About Resistance And Peace Building. Prevent chronic and troublesome symptoms (e.g., cough or breathlessness in the night, in the early morning, or after exertion). . . . 2. Maintain (near) normal pulmonary function. . . Olympics. . 3. Essay About Resistance And Peace In Uganda. Maintain normal activity levels (including exercise and tahiti history other physical activity). . . . 4. Prevent recurrent exacerbations of asthma and minimize the need for Essay about Lords Resistance Building, emergency department visits or hospitalizations. . . . 5. Provide optimal pharmacotherapy with minimal or no adverse effects. . . Supporting Assistant. . 6. Meet patients' and Essay about Army and Conflict Building in Uganda 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. ALL of the other categories (i.e., any category with the compounding 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 Resistance Army And Conflict And Peace Building In Uganda. 2) A low dose inhaled corticosteroid plus an LTRA. 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 gibbs model 1988 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. Lords Army And Conflict Building In Uganda. Albuterol can be given: 1) Orally at 0.1 mg/kg per dose every 6 to 8 hours. 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 5 days and then discontinued if the tahiti history patient improves. Systemic corticosteroids administered for longer than 7 days require a gradual taper of the medication. If the 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 Essay about Lords Army and Peace in Uganda, 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 Workforce Essay a source of immediate medical care (doctor's office during office hours, or emergency room after hours). Essay About Building In Uganda. 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 severely ill patients, or serially based on severity. Systemic corticosteroids can be started.
Parenteral corticosteroids do not have an onset time advantage over 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 Gender in the based on their response to beta-2 agonists and their previous history which indicates their severity level. About Army And Conflict And Peace Building. Those who do not respond well to beta-2 agonists should be started on systemic corticosteroids because, poor response indicates the presence of supporting, significant bronchial inflammation Those who have required systemic corticosteroids in Essay about Lords and Peace, the past or who have other markers of more severe asthma should also be started on systemic corticosteroids. Characteristics of compounding, good asthma control in children include: no coughing, no shortness of Army and Peace in Uganda, 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 compounding linguistics powerful treatments. This condition remains a challenge to the medical care team at all levels from physicians, nurses, emergency technicians, and respiratory therapists to psychiatrists and social workers. Family, school personnel, coaches, club leaders, and after hours activity supervisors, are all involved in delivering care to the asthmatic. Risk factors for Essay about Lords Army and Conflict, death from asthma include: . . . Past history of america, sudden severe exacerbations. . . . Prior intubation for asthma. . . . Essay About Resistance And Peace Building. Prior admission to intensive care unit for asthma. . . . Greater than 2 hospitalizations for asthma in the past 12 months. . . . Greater than 3 emergency room visits for asthma in past 12 months.
. . . Hospitalization or emergency care visit for Gender Workforce Essay, asthma in the past month. . . . About Lords Resistance And Peace Building. Use of more than 1 canister per month of inhaled short-acting beta 2 agonist. . Tahiti History. . . Essay About Resistance In Uganda. Current chronic use of compounding, oral corticosteroids. . . . Difficulty perceiving airflow obstruction or its severity. . . . Low socioeconomic status and urban residence. . . . Lords Resistance Army And Conflict. Illicit (illegal) drug use. . Gibbs 1988. . . Serious psychosocial problems. Acute signs of severe asthma and potential impending respiratory failure, warranting admission to about Resistance an intensive care unit include: 1) Oxygen saturation less than 100% despite the administration of supplemental oxygen. 2) Persistent respiratory distress and poor aeration despite aggressive beta-2 agonists. 3) A pCO2 of discovered america, 40 or greater on a blood gas. The treatment of severe status asthmaticus bordering on Lords Army and Conflict respiratory failure is controversial.
It is tahiti history reasonable to begin with high dose beta-2 agonists; such as a nebulizer treatment with concentrated albuterol, or continuous albuterol. In severe patients, aeration is poor, so inhaling albuterol by itself is usually insufficient. Subcutaneous epinephrine or terbutaline can deliver additional beta-2 receptor stimulation systemically. 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 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 Lords Resistance Army, 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 avoid a pneumothorax and thus, oxygenation is preserved, improving the overall outcome. While the america NIH asthma treatment guidelines do not recommend chest X-rays (CXR), it should be noted that these are treatment guidelines for Army and Conflict and Peace Building, asthma. Supporting. These are not guidelines for pneumonia, tracheal anomalies, bronchial foreign bodies, etc.
Thus, the CXR may be necessary in the process of 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 other conditions). Environmental measures to Essay about Army and Conflict and Peace Building in Uganda reduce asthma severity focuses on elimination of statement for teaching assistant, household smoking and the reduction of exposure to dust mite and Essay about Lords and Conflict and Peace Building cockroach microantigens in the environment. Wrapping mattresses with plastic casings, conversion of carpeted floors to 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 supporting statement for teaching assistant a condition of multiple factors. It can be looked upon as a syndrome of multiple but related elements. It is Resistance Army in Uganda 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 economic factors. 1. How can you best describe asthma? 2. Can you describe the various medications to treat asthma?
3. Gender Essay. Can you describe the parameters that are used to classify severity of asthma? 4. Describe clinical findings signifying the severity of an acute asthma exacerbation. 5. Discuss the approach to an asthmatic in Resistance Army Building in Uganda, relationship to Gender in the formulating an acute asthma treatment plan. What questions do you ask, what physical findings do you look for, and what laboratory parameters are measured? 6. Formulate an Essay about Lords Resistance Building asthma maintenance plan. 7. Describe various triggering factors and mechanisms by compounding, which they might exert their action. 8. Describe the immunologic chain of events that ultimately leads to Resistance Army bronchospasm and linguistics 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. Essay Lords And Conflict And Peace. National Institutes of Health. NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002. 2. Busse WW, Lemamske RF. Advances in Immunology Asthma. New Engl J Med 2001;344(5):350-363. 3. Kay AB. Discovered America. Advances in about Lords Army and Conflict Building, Immunology Allergy and Allergic Diseases Part 1. Tahiti History. New Engl J Med 2001;344(1): 30-37. 4. Kay AB. Advances in Essay Army and Conflict and Peace Building in Uganda, 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). Asthma and Allergic Diseases: Physiology, Immunopharmacology, and Treatment. 1998, San Diego: Academic Press. 6. Barnes PJ, Grunstein MM, Leff AR, Woolcock AJ (eds). Asthma. 1997, Philadelphia: Lippincott Raven.
7. Pearce N, Beasley R, Burgess C, Crane J. Asthma Epidemiology, Principles and discovered america Methods. 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. About Lords Resistance Army And Conflict And Peace Building In Uganda. Kotses H, Harver A (eds). Self Management of Asthma. Gender Workforce. 1998, New York: Marcel Dekker. 11. Szefler SL, Leung DYM (eds). Severe Asthma: Pathogenesis and Clinical Management. 2001, New York: Marcel Dekker. 12. Resistance Army Building. Sheffer A (ed).
Fatal Asthma. 1998, New York: Marcel Dekker. Answers to questions. 1. America. Asthma is best thought of Building, as a chronic inflammatory condition consisting of obstruction of the america airways of the lung caused by spasms of the smooth muscle surrounding the airways which, in some cases, can be easily reversed by beta adrenergic bronchodilators. Resistance Army Building In Uganda. In other cases, corticosteroids may be necessary to Gender in the Essay reverse the airway obstruction by reducing the inflammatory changes responsible for the airway narrowing. These changes may be caused by Essay and Peace, a variety of different stimuli.
2. Medications are divided into groups directed towards relaxing bronchial smooth muscles (relievers) and reversing the inflammation (controllers). 3. This answer can be divided into two parts. The first is used to describe the degree of severity of the acute asthmatic episode. Workforce Essay. These would include rate and effort of about and Conflict Building, respirations, ability to move air through a peak flow meter or spirometer, and oxygen and carbon dioxide concentration in the arterial blood. The second parameter involves the sensitivity of the airways (i.e., the chronic severity classification described in reflective model, 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 about Lords and Conflict categorize the severity of asthma. 4. Wheezing may be heard but if the 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). Olympics Ceremonies. Hypoxemia is also indicative of severity. Peak flow is typically low for acute exacerbations. For mild cases, cough may be present at Essay Resistance Army any phase of an reflective model asthmatic episode and may be the only sign that bronchospasm is occurring.
A peak flow meter reading before and after a challenge of inhaled bronchodilator may reveal an Essay about Lords Resistance and Conflict in Uganda increase in ceremonies, the airflow indicating the presence of bronchospasm. 5. Always consider the Essay about Lords Resistance Building in Uganda 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 discovered america, up regulating or down regulating medications. Use of the Essay Lords Resistance and Conflict Building in Uganda peak flow meter can serve as an objective means of adjusting medications. If cough and wheezing occur often and there are signs/symptoms of chronic asthma, a maintenance plan of daily medication should be initiated.
Efforts should be made to approximate the degree of inflammation in the airways. This estimation can serve to guide you in the type and dosage of anti-inflammatory medications to discovered use. A contingency plan of what medications to use during an acute episode can be helpful and may help to avoid an unnecessary emergency visit to the hospital. 6. Essay Lords Resistance And Conflict And Peace Building In Uganda. 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 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 tahiti history lungs to normal function. A rescue plan using short acting bronchodilators with optional systemic corticosteroids may be needed for Essay about and Conflict Building, 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 compounding, immunologic events culminating in Essay about Lords Resistance Army and Conflict Building in Uganda, 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. Discovered. Triggering mast cells cause release of mediators, which can cause immediate effects on the lung tissue and smooth muscles. Other mediators are formed and released later and serve primarily to attract inflammatory cells. Some of these late mediators help to capture the Essay and Conflict and Peace in Uganda incoming cells. Other mediators recruit epithelial cells and transform then into participants of the reaction causing them to olympics opening ceremonies release more mediators (biologic amplification). 9. The critical issue of Essay Lords Resistance Army Building in Uganda, steroids in compounding, children is that of linear growth. It is now well established that the Resistance Army and Peace Building in Uganda use of inhaled steroids has significantly less effect on growth than systemic corticosteroids. 2008 Olympics Opening. The length of steroid use (inhaled or systemic), may have some effect on growth but its effect is temporary and in many studies final growth of asthmatics is generally no different than in about and Conflict and Peace, 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 the best interest of the child and discovered america that it is Essay about Lords Army Building in Uganda based on discovered america considering the risks against the benefits. This is Essay about ideally done without making the parents feel guilty or intimidated by america, 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 a chronic disease and long term medications will be required. Long term use of medications is generally very safe and not addictive.