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Macroeconomic Analysis Essay Sample. Deciding to start a business is brave and plan adventurous. Outline Paper! The first step to success is a brilliant, viable, profitable idea. Whether you have decided to do it on your own because you are tired of working for someone else, or you are laid off after many years in your organization, before you decide to invest your life savings and get buried in debt, consider the big picture, the plan, current economy, your demographic target consumer and do your research. The idea of solar energy is one such brilliant, viable idea. True the demand is present for such energy, but before taking the leap, consider the market saturation, competition, governmental rules and regulations and other determent factor that will influence the success of your venture.
The American Economy. Annual percentage growth rate of GDP at market prices based on constant local currency. Aggregates are based on constant 2005 U.S. dollars. GDP is the sum of gross value added by all resident producers in the economy plus any product taxes and minus any subsidies not included in the value of the products. It is calculated without making deductions for depreciation of fabricated assets or for depletion and descriptive essays about degradation of natural resources. The United Stated economy and those of other high income economies are expected to grow by 1.9 percent in 2014, accelerating to 2.4 percent in 2015 and 2.5 percent in charter plan, 2016.
The Euro Area is on target to grow by 1.1 percent this year, while the United States economy, which contracted in critical religion, the first quarter due to severe weather, is expected to grow by 2.1 percent this year (down from the previous forecast of fishing 2.8 percent). The global economy is expected to pick up speed as the year progresses and is projected to expand by 2.8 percent this year, strengthening to 3.4 and 3.5 percent in critical essays society religion and government, 2015 and 2016, respectively. High-income economies will contribute about half of global growth in 2015 and charter 2016. (Bank, 2014) As you can see, the economic forecast for the United States is forecasted to rise over the next several years. Market saturation is save planet earth a situation in which a product has become diffused (distributed) within a market; the actual level of saturation can depend on consumer purchasing power; as well as competition, prices, and technology. (Investopedia, 2014) When a product of service is business plan first introduces, the goal is to get in on make thesis good the ground floor of the idea, before competition enters the market. Most competitors will enter the market and create that same or similar product, good or service with the thought process of making a profit. The problem may be the market you are targeting is saturated the product, good or service. This will cause decrease demand for your product, and fishing charter business plan a reduction in in profit, if any after paying your overhead. Unless you have the ability to enhance the product and basic outline paper somehow reinvent or upgrade it at a minimal cost to your business overhead while making it affordable for the consumer, you may find your product will not be in demand.
You will be fighting to sell in a saturated market. The value of your product will be reduced. When you consider your consumer market, let look at the current solar market in the United States and market saturation. GDP Target Markets. The United States the top solar states for total power capacity per capita and the top U.S. solar per capita and new solar power capacity are Arizona, Hawaii, Nevada, New Jersey and California.
The largest populous state is California that seems to have the largest total solar power capacity, new solar power capacity in the year 2012. The California market will prove to be a good area to market solar panel installation. California has become one of the largest solar energy markets in the United States due to incentives the state offers for installation of solar panel on roofs of homes and businesses. In addition, government subsidies help to business plan, fund installation projects. Choosing to do business in this region will be very competitive, but it seem there is still opportunity in these states. (Wang, 2013)
International trade is another option to consider when looking into marketing a product. Solar energy is outline for research paper a resource that can be utilized by fishing business plan any nation willing to thesis good, invest in this natural resource. According to the research attained from the EPIA’s 2012 Photovoltaic Barometer report, and data attained from population numbers from Internet World Stats (IWS) and the GDP numbers come from the International Monetary Fund (IMF), the top countries that utilize solar energy Sources are Germany, Italy and Belgium, (Shahan, 2013) whereas the top counties that trade with the United States are Canada, China Mexico Japan Germany and the United Kingdom. (Wikipedia, 2012) Considering the international market would open up additional opportunity to expand your target market. The countries that the United States trade the charter plan, most with still have demand for solar energy. Another important factor to consider when starting a business is the “business cycle.” The business cycle is the fluctuations in economic activity that an economy will experience over a period of time. We have experience may business cycles in the United States. We refer to them as expansions and recessions. In an expansions, the economic outlook is good and growth happens, without inflation.
Recessions are when the economy is shrinking and the determination factors for a recession include unemployment, low industry production, decrease sales and lower incomes. Since 1854, The United States has experienced 33 business cycles. Each consisting of expansions and recessions. (The National Bureau of Economic Research, 2014) The business cycle peaked in late December 2004, and headed downward through January 2006. Critical Essays! Increase global economic confidence caused rise in fishing business, 2007. The cycle continues to lower and raise on a steady basis with 2015 looking very positive. (Now and the Future, 2014) Unemployment is a major determinate factor on essay save the success of a new business venture to the impact unemployment has on the economy. Unemployment rate is defined as the charter plan, percentage of the labor force that is unemployed. The unemployment rate measures the percentage of the labor force that is unemployed: Determining the labor force is essential to estimate the unemployment rate in the United States.
The labor force is defined as the descriptive essays, percentage of the working-age population in the labor force. The labor force participation rate is important because it determines the amount of labor that will be available to the economy from a given population. The higher the labor force participation rate, the more labor that will be available and business the higher a country’s levels of GDP and about save planet GDP per person. (Glenn 643-646) When economic uncertainty exist, manufacturers cancel new investments and freeze the hiring process. Fishing Business Plan! Uncertainty in the economy harms economic activity, with effects similar to a decline in aggregate demand. Companies cut back on spending which causes unemployment to rise. When unemployment rises, there is a reduction in essay about save earth, output. (United States Department of Labor, 2014) Heightened uncertainty lowers economic activity and inflation, and thus operates like a fall in aggregate demand. During the Great Recession and recovery, we estimate that higher uncertainty has boosted the unemployment rate by at least one percentage point. Policymakers typically try to mitigate uncertainty’s adverse economic effects by lowering nominal interest rates. However, in the recession and recovery, nominal interest rates have been near zero and couldn’t be lowered further.
As a consequence, high uncertainty has been a greater drag on economic activity in the Great Recession and recovery than in previous recessions. There is a close relationship between unemployment and fishing business inflation. As more people work the national output increases, causing wages to increase, causing consumers to have more money and to make good, spend more, resulting in consumers demanding more goods and services, finally causing the prices of fishing charter plan goods and services to increase. This means that unemployment and inflation share an inverse relationship: inflation rises as unemployment falls, and inflation falls as unemployment rises. In this day and age, many countries depend on critical essays on israeli each other and if one economy suffers, somehow there is an effect on another country.
Whether the effects are from business plan a political event or the preference of one currency over another. Write Application! The United States has a trading relationship with many other nations. Fishing Plan! There has been an increase in the amount of good imported into the United States over the years, in addition to many goods from the United States that are exported to other nations. To regulate the international trade process, there are polices that promote and restrict the growth ot imports and exports which has an effect on the United States economy. Essay Save! Trade barrier exist that may hinder international trade. One of these barriers is tariffs and charter quotas. Trade barrier are often put into place during recessions, or when national unemployment rates are on the rise, or faced with competition from foreign companies, the government will but trade barriers in place to protect the statement good, industry to preserve the economy. Charter Business Plan! When participating in international trade, currency plays a major role in the process. Application Essays! The value of currency rises and charter business falls according to supply and demand. In addition, changes in preferences for goods and services in make, other countries reflects on fishing plan the supply and demand for different national currencies. A nation’s currency value is influenced by prices of goods and services in basic for research paper, the country, the nation’s inflation rate, interest rates and charter business the amount of investment opportunities.
The cost of United States investments rise as when the essay about steve jobs about microsoft, American dollar trades at business plan, a higher value that other national currency. Good! On the other hand, if the supply of plan dollars on the exchange market increased faster than the application, demand, the value of the US dollar will depreciate and look weak against charter other currencies. As of today the exchange rate for application essays one US dollar is highest exchange value is the Japanese’s yen. The value of the currency fluctuates according to that nation’s economy. Currently the US dollar is exchanging at fishing charter, a favorable values. (Oanda, 2014) Monetary Policy and descriptive Interest Rates. On a short term basis, monetary policy influences inflation and the economy demand for goods and services. During normal times, the Federal Reserve has a large influence over the financial conditions by adjusting the rate banks charge each other for short term loans. In addition to the banks benefiting, this low interest benefit is passed on to the households and firms. The goal is to influence firm and business household borrowing.
Short term loans are more attractive and borrowers feel as if they need to act to lock in the lower interest rate. When short term and long term interest rates decrease, it is cheaper to borrow, the consumer borrow and write application purchases goods and services, which helps firms justify hiring and increasing the plan, workforce, which boost production. About! It is fishing business plan interesting to note that the monetary policy influence is not instant and often does not appear immediately, do to outline format paper, measure the effects of the monetary policy on the economy can be difficult to charter business, predict. Monetary policy has a considerable significance on inflation. Federal fund rate reductions result in increased demand for good and good serviced and results in a wage and elevated cost, meaning a push for fishing plan demand for workers and materials to increase production.
Predictions can be made for the future of the economy, including predictions on price and wages when monetary policy is used and those expectations also influence the application, current inflation rate. The most recent monetary influence happened in 2008 when short term interest rates were at fishing business plan, zero. When interest rates are at zero, they are unable to fall any lower, therefore the Federal Reserve decided to support the economy by purchasing long term mortgage backed securities in addition to notes issued by certain government-sponsored enterprise and long term Treasury bonds and notes. Essay About Planet! The goal was to lower the level of longer term interest rates with hopes of improving financial conditions. Although considered non-traditional, this monetary policy measures where implemented through the same path as traditional policy. Charter Plan! (Francisco, 2004) Fiscal Policy and Unemployment. Fiscal policy is the essays, means by which a government adjusts its spending levels and tax rates to fishing charter plan, monitor and influence a nation’s economy. It is the sister strategy to monetary policy through which a central bank influences a nation’s money supply. (Heakal, 2014) The government takes measures to influence the economy by adjusting tax levels up or down.
The overall goal is to write application essays, contain inflation and decrease the unemployment rate and fishing charter business plan keep a blooming value on the US dollar. Recent government intervention and influence on essay about earth the US economy with fiscal policy is the American Taxpayer Relief Act of 2012. This act of influence was a move to increase tax rates and fishing business cut government spending. Government spending contributes to the deficit. The federal government budget deficit has fallen sharply in recent years?from almost 12 percent of GDP in 2009 to less than 7 percent in 2012. And recent budget reports show that the deficit is shrinking faster than expected only a few months ago, to a projected 4? percent of GDP for statement the current fiscal year, which ends September 30. Plus, health care cost growth has slowed down dramatically since the Great Recession, alleviating the pressure on public health care programs at least temporarily. (Igan, 2013) Deficit reduction is the primary goal of fiscal policy. It is believed that a lower deficit will reduce government borrowing which will have an effect on interest rates. As we learned, lower interest rates stimulate household and firm confidence and borrowing power. Firms will hire workers to keep up the demand for goods and services, therefore reducing unemployment. The government performs a balancing act when attempting to maintain tax rates and public spending.
If the balance tilts too far in one direction, inflation will rise or if the shift is fishing too far in critical essays on israeli and government, the opposite direction the value the dollar decrease. Due to this ongoing balancing act the fishing business, government does use fiscal policy to basic for research paper, curve inflation by application of brakes to the economy by increasing taxes to decrease the charter business, amount of money flowing into the economy. Government spending is also reduced which decreases the descriptive about places, amount of charter business plan money in circulation. About! The outcome of this fiscal policy application means a slow economy, increased unemployment. Nothing says economic confidence than a personal investment. By investing your personal savings to start a business in charter business plan, addition to borrowing helps the economy recover.
Thank advantage of tax an interest benefits serves to attract small business starts. According to the Biz2Credit Small Business Lending Index, the essay about about, small business loan approval rates at big banks ($10 billion+ in assets) increased 17.6% in December 2013 from 17.4%. Further, in a year-to-year comparison, lending approval rates at big banks have increased nearly 20%. The recession of affected small business owners in 2009 -2010, however, the fishing plan, 2011 – 2013 banks are confident and are lending to potential borrowers. As a female business owner, it is essential to do your due diligence in researching the best start up opportunities such as borrowing method, institution, market and chances for success. We have learned that the market you target can be national or international, therefore there are many opportunities for success in that arena. Starting up is the critical essays and government, hardest part. According to fishing plan, Biz2Credit,the The Top 25 metro areas by annual revenue were: Jacksonville, FL; Charlotte-Concord-Gastonia, NC-SC; Chicago, IL-IN-WI; Denver, CO; Pittsburgh, PA; Atlanta GA; Los-Angeles-Long Beach-Anaheim, CA; Las Vegas, NV; Dallas-Fort Worth, TX and San Francisco-Oakland CA. Thesis! Consideration of start up in these locations will provide a good chance of business success. Consideration of the annual revenue of t the demographic area will help estimate the success of the overall economy of your city and the viability of your new blooming business. If you choose to borrow funds, consideration of the credit score of your demographic area is essential as well.
When sorted by Credit Score, Portland was the leader. Rounding out the Top 25 were Denver, San Francisco-Oakland, Los Angeles-Long Beach-Anaheim, Las Vegas, New York metro, Chicago, Pittsburgh, Indianapolis, and Seattle. (Biz2Credit, 2014) Recommendations and Economic Justification. The decision to fishing charter plan, venture out and be a business owner is one that required considerable thought and essays planning. Knowing when to get into the market as a small business owner is essential. Having a strong understanding of the national and international economy is essential in order to make intelligent informed decision. Understanding how business cycles work, and the ability to identify a time of expansions and recession will help you identify the fishing charter business, best time to essays places, go forward with your venture. Fishing! Understanding how monetary and fiscal policies can affect the timing and the length of each business cycle will help you choose a most beneficial time. During a time of essay about planet expansion the economy will grow, causing an influx of business and job growth.
This is the recommend time to jump into the market. Knowing that all cycles must peak, the Federal Government will intervene and attempt to slow down this growth by increasing interest rates to stop inflation. Fishing! Knowing this slowdown will cause the economy to slow down, prepare your business to weather this storm. Business demand is driven by increasing the income and make statement good consumption taxes which directly reflects on the amount of plan disposable income which slows down business activity. Understanding your market and effectively reaching your consumer with goods and services that are in make good, demand is a determinate factor in for your business success. Fishing Business Plan! The correct demographic area to implement your startup venture is key to success. Researching other small business success, longevity is essential to choosing the correct location. Descriptive Essays! In addition, ensuring you are not marketing a product that is currently saturated by competition is another factor of importance. Fishing Business Plan! Solar energy is a resource that is essays on israeli society religion very popular. The competition in this area is stiff, but I foresee opportunity in this area a business. The solar power panel industry has overcome a low and is now booming again.
There was an oversupply of panels which caused prices to drop, making solar power panels competitive which increased the overall demand. Installations are expected to increase. Having a keen understanding of the solar power panel manufactures will help provide strategic planning. Bank, T. W. (2014, June 01). Global Economic Prospects. Retrieved from Shifting priorities; building for the future: http://www.worldbank.org/en/publication/global-economic-prospects Biz2Credit. (2014). Knowledge Center . Retrieved from Research Reports: http://www.biz2credit.com/research-reports/2014-best-small-business-cities-in-america-women Francisco, F. R. (2004, February 06). U.S.
Monetary Policy: An Introduction. Retrieved from business How does monetary policy affect the U.S. economy?: http://www.frbsf.org/us-monetary-policy-introduction/real-interest-rates-economy/ Heakal, R. (2014). Investopedia. Retrieved from What is Fiscal Policy: http://www.investopedia.com/articles/04/051904.asp Igan, D. (2013, July 30). iMFdirect. Retrieved from U.S. Fiscal Policy: A Tough Balancing Act : http://blog-imfdirect.imf.org/2013/07/30/u-s-fiscal-policy-a-tough-balancing-act/ Investopedia. (2014, December 3). Market Saturation. Retrieved from. Is this the perfect essay for you?
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Good luck! Hello. Which is good for cabin crew applicant? I have no many work experience in fishing charter business service. So i want to highlight the other things. Make Good? Thanks #128578; Take a look at our Flight Attendant resume sample: https://resumegenius.com/resume-samples/flight-attendant-resume-example You can download it and input your own information. Which template would you recommend for a career in education? Check out business our teacher resume samples: https://resumegenius.com/resume-samples/teacher-resume-example You can download them and input your own experience. Try using the ‘Freeman’ template.
Best of luck on the promotion! Hi! What resume template would you recommend for about earth, a college freshman trying to apply for a competitive summer program with the USDA and South Dakota State University? Sound like the ‘Entry-Level’ template would be a good fit for what you’re trying to plan, do. Good luck with the about, summer program. Hi!
Which resume template would you recommend for someone trying to tap into the finance and accounting market. Looking for an entry-level position. You should go with the ‘Entry-Level’ template. Good luck with the job hunt. I have worked 32+ years as a nurse, the last 4 years taking care of my elderly father and online work. Now seeking to get back into the job market for extra income, not necessarily in the health field, just to earn some income and socialize. What resume do you suggest? Try the ‘Job Hopper’ template. Good luck with your job search! Hi! What resume template would you recommend for a 9th grader trying to apply for a doctor (any)??
Apparently, resume making and interviewing is our project for the fourth quarter this year. I couldn’t find any clear examples on the web, and I was hoping you could help me out with what template I should use.. Try using the ‘Elegant 2.0’ template. Fishing Charter Business Plan? Good luck on your project. Yes, if you click the View all Resume Designs button and click the download link for the template pack of essays your choice. If you’ve never written a resume before, I’d recommend checking out fishing charter our “How to Write a Resume” guide to get a clearer idea (it’s much more comprehensive than any answer I can give here). https://resumegenius.com/how-to-write-a-resume. Hit us up with any follow-up questions after giving that a read we’ll see if we can help further! Good luck! Hey there Margaret, In order to best understand which template works, it’s a good idea to check out which resume format fits your particular needs; then you can take it from there. https://resumegenius.com/resume-formats.
All of the templates were created by professional resume writers, so it’s hard to about about, go wrong with any of them — it just depends on fishing business plan, your preference. Make Statement Good? Good luck! It really depends on charter, what job you’re applying for. Write? Since you have substantial work experience, try quantifying that in your resume (think: any numbers that a hiring manager can look at plan, and better understand what you accomplished during your time working there). Check out steve jobs about this page and choose the one you find most fitting, that should be a good start: https://resumegenius.com/resume-formats. Good luck on the job hunt! Hey there hbil036, This way, you can focus on your skills qualifications critical to the job application. As an aside, you may want to look into whether you’re qualified to get back into accounting after that many years outside of the field. I understand that some regulations and fishing charter, rules change over the years — it may just be a matter of taking a test or updating your certifications, but I’m not certain.
If that doesn’t seem to be a problem then go with the functional resume for sure. Good luck on the job hunt! If you are lacking in major experience, I’d recommend using a reverse chronological format for save planet, your resume. Our “Classic” template on this page should do the trick: https://resumegenius.com/resume-templates/ Good luck at the job fair! I recommend you first check out our internship resume sample page: https://resumegenius.com/resume-samples/internship-resume-example. Afterwards, feel free to choose any format – just use a comprehensive education section instead of a professional experience section, and you should be good. Good luck landing that internship!
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Charter business - The Hull Truth - Boating and Fishing Forum
4 Steps to Effective Book Summaries with Mind Maps. Mind maps are a fantastic way to capture information and ideas. Fishing Charter Plan? They also happen to be our preferred way to capture information from books and other written media. Why mind maps? Because it is much faster to critical essays society review a mind map than it is an charter, entire book. You can get all the main ideas of critical essays on israeli society, a book from just reading the first-level nodes of fishing business plan, your summary mind map, and essays, if you need more granularity, you can drill down into each node to find what you#8217;re looking for.
Mind maps are ideal for creating effective book summaries. Fishing? Here#8217;s a simple 4-step process for reading and creating an accessible mind map for descriptive essays places future review. Plan? What you#8217;ll need. The tools you will need to pull this off. 4-Step Process. 4 simple steps to write application essays go from book to easily reviewable mind map. You need 3 things: The book . This is obvious. Charter Business Plan? If you can get the book in digital form (be that Kindle, iBooks/EPUB or PDF), that#8217;s even better. Mind mapping app . We personally like MindJet MindManager. We#8217;ve also used Mind Node (but it#8217;s not as pretty) and basic outline format for research, Freemind (free, but really not as pretty). A basic task manager , for setting review dates.
We like OmniFocus. You can also use a built-in Reminders app like the fishing charter business, one on OS X or Outlook to set reminders for specific dates. Specific dates in critical on israeli society Reminders. The first thing you want to do is fishing charter plan, establish your purpose for reading the book. Is there something you want to know or learn about in particular? Is there a set of beliefs you would like to reinforce with what you read in essays the book? Whatever your purpose is (expanding knowledge, completing coursework, application) you need to fishing charter business know it and it needs to essay about steve about be clear from the fishing, get-go. Without it, you#8217;ll be reading without direction and it will be much more difficult to mentally sort out relevant information for your mind map. This is descriptive essays about, really straightforward read the book! Use a highlighter and pencil to fishing business take notes if you like, or if you#8217;re on a tablet or other digital device then you can easy highlight/note within your reading app.
After you#8217;ve read the book, you want to sit down and create your mind map. This will reinforce what you#8217;ve just read and learned, and also lets you rearrange the content of the book to better match your own way of write, thinking, rather than relying on the author#8217;s chapters and structure. It essentially lets you filter the content of the book through the fishing business plan, lens of basic outline format, your established purpose. Here are some technicalities when it comes to mind mapping a book: You can mind map by fishing business plan chapters or major concepts. If you like the jobs microsoft, author#8217;s structure, go with chapters. Plan? If not, create your own based on what you think are the main concepts.
8-12 top-level nodes is enough. Try to make the 1-4 word phrases, e.g., #8220;task management principles#8221;. You can drill down into basic for research paper as deep a level of detail as you like. If a particular idea is business, more important to you than another, then go deep on that. Have one node called #8220;Implementation#8221; or #8220;Action#8221;. I like to color mine a bright orange.
Under this node, list all the essays places, Actions from the book that you will take things that you#8217;ve read, highlighted and then noted as #8220;oh, I need to implement this#8221;. This forms a handy reference list that you can look at and then simply do. Highlight important ideas on your mind map by using different colored text or nodes, or bolding or increasing font size. Use callouts where necessary. Our preferred usage for callouts is for #8220;ideas about business plan, ideas#8221; perhaps a personal comment about a given idea we#8217;ve written down in about jobs the mind map. Use relationships to tie together different parts of the book. If one concept naturally leads into another or needs to reference another, draw a relationship line between the two.
Lots of Relationships. When you#8217;re done with the mind map, get up and go get a glass of fishing charter business, water or walk around for a bit. Then come back, and rearrange the information in essay about planet earth the mind map so that it makes sense to you . Remember that it#8217;s going to be you who is reviewing it down the line. If you want to systemize your reviews, open up your Reminders application or task manager and create a list that looks like this: Book Summaries Review in fishing charter business Reminders App. About Places? Set yourself task reminders to review the fishing business plan, mind map at these intervals: 3 days later 3 weeks later 3 months later 1 year later 2 years later 3 years later 4 years later 5 years later. During each review, look over the main concepts and drill down to where you want more detail. Look at descriptive essays about places, the Action Node and see what you#8217;ve implemented or not. Now you have a simple 4-step process for reading and fishing charter business, creating effective book summaries with mind maps. If you want to learn to read faster, check out our article on speed reading.
Or if you#8217;re looking for a good book to test this out on, check out the Asian Efficiency Primer it#8217;s a collection of our best content, all in one accessible volume. Outline Format For Research Paper? Take our Productivity Quiz to find out. Learn the tactics and charter business plan, techniques that will work for thesis statement you. what is lacking is discussion on how to manage those huge mindmaps which are difficult to print and too small to business read on the computer screen. Any reason they can#8217;t be read on a computer screen? I have quite a few of those and don#8217;t have any problem reading them. I did a site search. to see if AI had anything on book summaries. Over 20 years ago I bought #8220;The Great American Bathroom Book#8221; vols I-III and while I know reading the actual book gives a person something they won#8217;t get by reading summaries, there is descriptive essays, a time and place for summaries. Those three books above I#8217;ve spent hours with, they#8217;re fantastic imo. As far as digital and business related books, there are some competing book summaries companies out there and wanted to know which one AI recommended. Fishing Charter? 1 gives the raw number of society religion and government, book summaries available, getabstract is way ahead.
2 says that soundview is still the best in their opinion, comparing the charter, samples each offers, I agree but to me volume is key so getabstract has the advantage at this point in time. Asian Efficiency is dedicated to making the world a more productive and efficient place. Learn More. Discover the top 10 apps and tools of the productivity pros: Copyright 2017 Asian Efficiency. Get our Productivity Toolbox ($19 value) for FREE that will show you how to work less and save 1.5 hours a day. You'll get the top 4 productivity apps (#1 and #3 are free) Stop co-workers from wasting your time with this one electronic gadget The alternative to coffee that gives you MORE ENERGY and doesn't give you the caffeine crash (and it's all natural) Revealed: The Morning Routine of Highly Productive and Successful People. Download our free report that reveals the morning routines of Oprah, Tim Cook, Tony Robbins and other highly successful people. Get the 6-step morning routine (that takes less than 30 minutes to do) of highly successful people Upgrade your morning routine with this one simple tweak for more energy in the mornings Banish anxiety and application, feeling rushed while getting ready for work. NEW: Find Out What Your Productivity Score Is! This new personality quiz can show you how productive you are. In less than 3 minutes you'll find out:
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Charter business - The Hull Truth - Boating and Fishing Forum
case study on charter asthma Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. Chapter VIII.2. Critical Essays Society Religion And Government! Asthma. Return to Table of Contents. A three year old comes in with a complaint of coughing for 2 weeks.
Coughing is present every night. He has also had a mild fever, but his temperature has not been measured at charter, home. About Steve Jobs Microsoft! 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 charter business noted to have morning sneezing and essays, 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 foods or medications. His past history is notable for eczema and dry skin since infancy. He is fishing 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 steve microsoft, room air. He is charter business alert and cooperative in minimal distress if any. Basic Outline Paper! His eyes are clear, nasal mucosa is fishing charter business boggy with clear discharge, and about, his pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes palpable in fishing charter, his upper neck. His chest has an increased AP diameter and it is tympanitic (hyperresonant) to percussion.
Rhonchi and occasional wheezes are heard on essay about save planet auscultation, but there are no retractions. Heart is in fishing charter plan, a regular rhythm and no murmurs are heard. His skin is dry, but not flaky, inflamed or thickened. He is initially felt to have moderately persistent asthma and possible asthmatic bronchitis. He is initially treated with nebulized albuterol and nebulized corticosteroids for bronchospasm and about save, bronchial inflammation. He is also treated with an 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 fishing charter plan present. His cough persists, but only with exercise and make thesis good, drinking cold juice.
His chest now sounds clear in fishing charter, the office. After one week of essay jobs microsoft no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. His exercise induced cough gradually resolves. His nebulized corticosteroid is replaced with nebulized cromolyn twice a day and oral montelukast (a leukotriene inhibitor) is added. He enrolls in a soccer league and plays with minimal coughing. His routine nebulized albuterol+cromolyn is stopped and is used only pre-exercise to prevent exercise induced bronchospasm. No cough is observed at charter, 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 basic format paper, 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 air pollution, and charter plan, 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 paper, allergies, asthma is now considered to be a syndrome consisting of bronchospasm, airway hyperirritability, and fishing plan, inflammation. The popular term ROAD (reversible obstructed airways disease) or RAD (reversible airway disease) is not entirely accurate since this is only part of the disease process and reversibility may not always be evident. This is because obstruction of the airways may be secondary to mucous plugging or inflammatory changes decreasing the caliber of the airways, in which case, beta-2 bronchodilators are ineffective. Currently the basic outline, NIH Guidelines (1) have served as a standard for charter business plan diagnosing and treating asthma.
NIH guidelines provide: 1) An objective means of essay about save earth measuring asthma via the peak flow meter. Fishing Plan! 2) A way of objectively categorizing severity classes of patients based on symptoms and/or peak flow measurements. 3) A comprehensive pharmacologic plan primarily designed to treat inflammation, inclusive of critical essays on israeli religion and government provisions for acute and fishing, maintenance care, for statement good each severity level. 4) For the fishing charter plan, identification and removal of (or control of exposure to) known triggers. 5) The direction for essay save earth forming a partnership with the physician who uses education as a primary basis of this relationship. The realization that IgE existed and could be found in allergic individuals propelled the field of allergy and understanding of asthma into a renaissance of elucidating the actual pathophysiology of allergic diseases. Asthma is now understood to be a chronic inflammatory disease condition with periodic exacerbations. This is in contrast to viewing asthma as a purely bronchospastic condition. An acute asthma exacerbation is a biphasic process.
Understanding the inflammatory process of asthma came about when it was observed that 4 to 8 hours following allergen exposure, wheezing would occur that was not responsive (or less responsive) to beta agonists but it was ablated by cromolyn and corticosteroids. However, beta agonists could easily neutralize the immediate reaction, occurring within minutes of the allergen exposure. This created a picture of a biphasic reaction to allergen (or infection) induced wheezing. The first phase was described as the immediate (bronchospastic) phase and the second phase as the late phase inflammatory response. In the early phase of allergic inflammation, preformed mediators such as histamine and rapidly formed mediators such as leukotrienes are released and 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 fishing charter business, subepithelial structures. These events eventually result in extensive restructuring of the normal histology of the airways. This damage is not restored by beta-2 bronchodilators. An important immunologic occurrence is the about jobs about microsoft, activation of the Th2 helper cell, which is pivotal in the progression of the business plan, 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 essay about planet, airways.
The characteristic features of asthmatic inflammation are: mast cell activation, inflammatory cell infiltration, eosinophils, macrophages, neutrophils (particularly in fishing charter plan, sudden-onset, fatal exacerbations), lymphocytes (TH2-like cells), edema, denudation and disruption of the bronchiolar epithelium, collagen deposition beneath the basement membrane (this is an 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 about save planet earth asthma. Asthma is present 24 hours a day, 7 days a week. Charter! 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 save planet, patient presents with acute shortness of breath. Depending on the underlying degree of inflammatory damage of the airways, the episode may have been festering with persistent cough and occasional bouts of shortness of breath for weeks. Failure to attend to these soft signs of asthma in transition may lead to an acute case of status asthmaticus. Fishing! Hence, paying attention to signs of silent asthma (asthma not in an acute phase), can prevent costly and life threatening consequences. Asthma may appear solely as an application, 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 fishing business plan managed well, then the cough and wheezing may occur several days after cold symptoms. Hence, early recognition of asthma in transition is a major point of cooperation involving the physician and patient. An asthma management plan should include a maintenance plan and provisions for acute onset wheezing. Asthma in its most manageable state, is outpatient asthma, as opposed to hospital status asthmaticus. For most medical professionals, the first and everlasting impression of asthma is in essay jobs, hospital status asthmaticus. By far, the fishing, more common situation is asthma outside the hospital, in its non-acute form. Therefore, it is about steve jobs microsoft highly desirable that medical professionals familiarize themselves with the fishing, other faces of statement asthma to facilitate diagnosis and treatment.
The type of medication used to fishing charter business, treat asthma reflects the essay steve jobs about microsoft, mechanism of airway obstruction: bronchospasm versus inflammation. This is an extremely simplified version of what really goes on and new pieces of the intricate mechanism are being uncovered. Fishing Business! However from a pragmatic standpoint, the logic for appropriate use of individual medications for asthma can be understood by make thesis statement recalling the biphasic reaction. Based on this brief description of the mechanism of asthma, it is now possible to fishing plan, create an good, asthma treatment program. Genetics aside, elimination of triggers and aggravators of asthma such as allergens, cigarette smoke, and plan, environmental and industrial pollutants, can prevent acute exacerbations of asthma and serve as the first line of defense. Conditions such as weather changes and essays society religion and government, respiratory infections fall outside of the readily controllable factors. Approach to Asthma. . . . . . Charter Business! 1. Diagnose asthma and classify severity. Identify aggravating and triggering conditions. . . . . . 2. Prepare an initial treatment plan to stabilize the acute condition. Critical Essays On Israeli Society Religion And Government! Instruct patient and parents on signs and symptoms which help to monitor the effectiveness of fishing charter plan treatment.
If practical, treat other aggravating and co-morbid conditions concurrently. . . . Critical On Israeli Religion! . . Fishing Charter Business! 3. When asthma is stable, proceed to a maintenance plan to allow healing of the damaged airways. This may take weeks to months. About Save Planet! Prepare an asthma action plan for up-regulation of medications for unexpected exacerbations. . . . . . 4. When there are no signs of breakthrough cough or wheezing, indicating that the airway hyper-reactivity has subsided and charter plan, is controlled, switch to application, a long term maintenance plan. Business! 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 reminder messages of essay about jobs microsoft avoidance and check on patients' inhalation technique of medication administration. Inflammation in asthma contributes to: airway hyperresponsiveness, airflow limitation, respiratory symptoms, coughing, wheezing, shortness of breath, rapid breathing, chest tightness, persistent symptoms, and pathologic damage, even when symptoms are not present. It is fishing business often thought that periodic control of critical on israeli society religion and government acute symptoms is sufficient, but this is 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 gastroesophageal reflux have profound influence on asthma. Fishing Charter Plan! Their presence makes asthma extremely difficult to control. The main goal is to keep the patient functional and free of side effects from essays, medications. With this approach, asthmatics have been able to participate in business plan, a normal life style. Asthma is more than an make statement, acute process. A large part of treating asthma successfully is to be able to recognize asthma in its early stages and to formulate an appropriate treatment plan before the asthma advances to a critical stage. It is fishing plan simple to statement, diagnose asthma when the patient is wheezing, displaying intercostal retractions and turning pale or blue. Fishing Business! Great clinical skill is good required to make a diagnosis of asthma when sub-clinical and/or non-acute asthma is present. A careful detailed history and fishing business plan, 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 airways of the lungs which exhibits recurrent bronchospasm. These chronic symptoms may present itself as cough with exercise, cough with colds, cough with laughter, or cough at night.
A peak flow meter can consistently record airflow readings compared against normal values for sex and age. Signs of silent asthma (when no wheezing is heard) include: persistent cough at night, cough with exercise, cough with laughter, cough when consuming cold foods or drinks, prolonged cough following or accompanying a cold, feeling of tight chest or difficulty breathing. The peak flow measurement and FEV1 (forced expiratory volume over one second) are effort dependent measures. Full pulmonary function testing is desirable; however, the equipment is expensive compared to an inexpensive peak flow meter. About Earth! The ultimate objective measurement for asthma is by body plethysmography (body box), which can measure the end expiratory residual lung volume as well as resistance to airflow. For those patients unable to perform peak flow measurements, clinical history is all you may have to base your conclusions. Business! This includes a major group of essay about steve jobs younger asthmatics from fishing, infancy to 4 or 5 years old. 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 essay steve, respond to record what they feel, see, and hear may have a problem forming conclusions based on charter business plan history alone. Essays! 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 charter business 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. Good communication and availability to answer questions and concerns are basic to the partnership. Part of your efforts as the treating physician should be focused on getting the patient to respond in a logical manner to cope with changes in outline format for research, his/her clinical state. This is based on the patient understanding the principles of: triggers and aggravators, bronchodilation, inflammation, airway hyper-reactivity and healing. Charter Plan! 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 write application essays, situation resolves, the patient is advised to downgrade their medications back to fishing charter plan, their maintenance program. Should there be an unanticipated episode of wheezing, immediate activation of the action plan and statement good, consultation with the physician for additional treatment schemes is the next step. This up and down regulation of medications can be done without a physician visit. Phone calls, informing the physician's office of these maneuvers, are all that is normally required.
Obviously, recurrent wheezing episodes, even if reversed easily might indicate the presence of an unstable condition requiring an adjustment in the basic asthma management plan. 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 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 charter, steps as follows: Step 1 (mild intermittent): Day symptoms two days per week or less and night symptoms two nights per month or less. Descriptive! Chronic peak flow is 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. Charter Business Plan! Chronic peak flow is still 80% of essay about microsoft expected or higher. Step 3 (moderate persistent): Day symptoms occur daily or night symptoms occur more than once per week. Chronic peak flow is 60% to 80% of expected value. Step 4 (severe persistent): Continual day symptoms or frequent night symptoms. Chronic peak flow is less than or equal to 60% of expected value. The use of peak flow in the above classification is not required in 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 business plan, allow the child to critical on israeli society and government, express and fishing, 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. Along the way, it is crucial to basic, cradle the impressionable self image so that the child does not have a negative view of himself or herself. The very impressionable years are from about 3 to 10 years of age, when children form their life-long mental image of themselves. Discussions involving asthma management should, therefore, be handled cautiously with this in mind. Asthma should be viewed as a chronic illness which may continue to adulthood. In 1896 Solis-Cohen published, The use of adrenal substances in the treatment of asthma (adrenalin or epinephrine is a fast and potent bronchodilator). Epinephrine (most commonly administered subcutaneously, but it could be inhaled as well) was the first line of treatment for acute asthma from the 1950s through the 1970s and 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. Charter Business Plan! Interestingly, the ancient Chinese boiled the ephedra root in strong tea for their concoction to treat asthma. The tea contained theobromine, a methylxanthine.
Although methylxanthines such as theophylline are effective bronchodilators, they have been largely replaced by beta-2 agents (e.g., albuterol) which have a faster onset and less toxicity. Adding theophylline does not appear to acutely benefit most patients who are receiving high therapeutic doses of albuterol. Theophylline's main use is in long term chronic administration for more severe asthmatics. This change in therapeutic approach from on israeli religion, methylxanthines to beta-2 agents did not further our understanding of the fishing, true pathophysiology of essays and government asthma, as bronchodilation was the business, only target of critical society treatment. Plan! 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 critical essays on israeli society, less side effects.
Bronchodilators Used in Asthma. A. Business! Beta-2 Agonists: . . Format Paper! . albuterol (Ventolin, Proventil, also called salbutamol outside the USA) - MDI, Neb, PO. . . . L-albuterol (Xopenex - active isomer only) - Neb. . . . terbutaline - MDI, Neb, PO, SC. . . . formoterol (Foradil - very long acting) - DPI. . . . salmeterol (Serevent - used for maintenance therapy) - DPI, MDI. . . . epinephrine (alpha and beta) - MDI, Neb, SC. . . . ipratropium bromide (Atrovent) -MDI, Neb. . . . oxitropium bromide (Oxivent) - MDI.
. . . aminophylline - PO, IV. . Fishing Charter! . . 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 application, 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 become engaged in its active phase. Their action does not take place directly on the inflammatory tissue but by modulating DNA production of pro-inflammatory cytokines. Plan! Their effects are very broad and nonspecific. Steroids affect virtually every phase of the inflammatory process. They have an array of impressive and undesirable side-effects, which cause hesitation in their use by physicians as well as patients. Essay About Save! As in the use of any medication or therapeutic agent, the employment of steroids is subject to charter plan, weighing the desired effects against essay 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 fishing charter, be used on critical society and government 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 major side effect of chronic inhaled corticosteroids. Catch-up growth occurs in charter business plan, most instances, if the child's condition improves to the point at which inhaled corticosteroids are no longer needed. Thesis Good! 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 fishing plan corticosteroids). Corticosteroids used in Asthma. . Essay About! . Fishing Charter Business! . beclomethasone (Beclovent, Vanceril) - inhaled. . . . Write Essays! triamcinolone (Azmacort) - inhaled, IM.
. . . budesonide (Pulmicort) - inhaled. . . . fluticasone (Flovent) - inhaled. . . . Business Plan! flunisolide (AeroBid) - inhaled. . . Basic Format Paper! . 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). Fishing Business Plan! These leukotriene inhibitors were developed to basic outline, counteract the all important late phase inflammatory reaction caused by SRS-A (slow reacting substance of fishing plan 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 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 essay about, MDI. Business Plan! Nedocromil (Tilade) is available via MDI.
Goals of Asthma Treatment. . . . Basic Format Paper! 1. 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. . . . 3. Maintain normal activity levels (including exercise and other physical activity). . . . Charter Business! 4. Prevent recurrent exacerbations of asthma and minimize the need for emergency department visits or hospitalizations. . . . Basic Format For Research! 5. Provide optimal pharmacotherapy with minimal or no adverse effects. . Fishing Business Plan! . . 6. Meet patients' and families' expectations of and about, satisfaction with asthma care. Specific asthma therapy measures to achieve these goals are based on business plan the NIH severity categories.
Step 1 (mild intermittent) requires no daily medications. ALL of the other categories (i.e., any category with the 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. Essays! 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. 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 the above chronic (long-term) recommendations, acute exacerbations are treated with quick relief (or rescue) medications, which is most commonly prn albuterol and fishing charter plan, optional short bursts of systemic corticosteroids. Albuterol can be given: 1) Orally at format for research paper, 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 patient improves. Systemic corticosteroids administered for longer than 7 days require a gradual taper of the fishing charter business, 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 good, avoid the confusion caused by modifying their chronic medications. All patients should have a written asthma management plan that describes their chronic medications and charter business, a plan for the initiation of a rescue plan based on their symptoms and thesis good, peak flow (if age 5 years). More detailed plans can include recommendations to step up or step down their chronic medications as their chronic symptoms worsen or improve. If dyspnea still persists, despite rescue medications, then the asthma management plan should refer the patient to a source of immediate medical care (doctor's office during office hours, or emergency room after hours). Serial treatments with beta-2 agonists (usually albuterol or L-albuterol) with or without ipratropium are most commonly given. Plan! Inhaled beta-2 agonists can be given continuously for make statement good 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 based on their response to beta-2 agonists and their previous history which indicates their severity level. Those who do not respond well to business, beta-2 agonists should be started on systemic corticosteroids because, poor response indicates the presence of write application significant bronchial inflammation Those who have required systemic corticosteroids in the past or who have other markers of more severe asthma should also be started on fishing charter business systemic corticosteroids. Characteristics of good asthma control in children include: no coughing, no shortness of breath or rapid breathing, no wheezing or chest tightness, no waking up at night because of asthma symptoms, normal activities including play, sports, and exercise, no episodes of asthma that require a doctor visit, emergency room visit, or urgent care, no absences from school or activities, no missed time from work for the parent or caregiver, normal or near normal lung function, and a healthy self image (i.e., nothing can stop me attitude).
Unfortunately, the death rate from asthma is not yielding to the introduction of many excellent and essay about, powerful treatments. This condition remains a challenge to the medical care team at all levels from fishing business plan, 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 steve jobs microsoft, delivering care to the asthmatic. Risk factors for death from asthma include: . . . Past history of sudden severe exacerbations. . . . Prior intubation for asthma. . . . Prior admission to business plan, 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 make thesis statement good, past 12 months.
. . . Hospitalization or emergency care visit for asthma in the past month. . . . Use of more than 1 canister per fishing charter month of descriptive about inhaled short-acting beta 2 agonist. . Fishing Plan! . Write Application! . Fishing! Current chronic use of oral corticosteroids. . . . Difficulty perceiving airflow obstruction or its severity. . . . Low socioeconomic status and urban residence. . . . Illicit (illegal) drug use. . Essays Places! . . Serious psychosocial problems. Acute signs of fishing business plan severe asthma and potential impending respiratory failure, warranting admission to 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 40 or greater on a blood gas. The treatment of severe status asthmaticus bordering on respiratory failure is controversial.
It is essays on israeli and government reasonable to business, 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 jobs itself is usually insufficient. Fishing Business Plan! 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. Application! If the patient fails to improve and fishing business plan, 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 basic maintaining oxygenation. Attempting to normalize the pCO2 with aggressive positive pressure ventilation will increase the likelihood of 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 fishing charter preserved, improving the overall outcome. While the NIH asthma treatment guidelines do not recommend chest X-rays (CXR), it should be noted that these are treatment guidelines for asthma. These are not guidelines for pneumonia, tracheal anomalies, bronchial foreign bodies, etc.
Thus, the essay steve jobs about microsoft, CXR may be necessary in the process of evaluating some patients to be certain that the charter business plan, 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 reduce asthma severity focuses on elimination of household smoking and about, the reduction of exposure to dust mite and 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 a condition of multiple factors. It can be looked upon as a syndrome of multiple but related elements. Fishing Charter Plan! It is basically a chronic condition with biphasic components which both result in airflow obstruction by different means. The treatment should take into account the various triggering factors, occupation, age, psychosocial, and economic factors. 1. How can you best describe asthma? 2. Can you describe the various medications to treat asthma?
3. Essay About Save! Can you describe the charter, parameters that are used to make thesis good, classify severity of asthma? 4. Fishing Charter Business! Describe clinical findings signifying the severity of an acute asthma exacerbation. 5. Discuss the approach to an asthmatic in relationship to 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. Essays! Formulate an asthma maintenance plan. 7. Describe various triggering factors and fishing, mechanisms by which they might exert their action. 8. Describe the descriptive about, immunologic chain of events that ultimately leads to bronchospasm and inflammation. 9. Discuss the pros and cons of charter corticosteroid use in children and compare them with use in adults. 10. How would you convince parents of make statement good asthmatics to use medications when their children are not openly symptomatic?
1. National Institutes of Health. NAEPP Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002. 2. Busse WW, Lemamske RF. Advances in Immunology Asthma. New Engl J Med 2001;344(5):350-363. 3. Kay AB. Advances in Immunology Allergy and Allergic Diseases Part 1. New Engl J Med 2001;344(1): 30-37. 4. Kay AB. Advances in Immunology Allergy and Allergic Diseases Part 2. New Engl J Med 2001;344(2):109-114.
5. Marone G, Austen KF, Holgate ST, Kay BA, Lichtenstein LM (eds). 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 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. Kotses H, Harver A (eds). Self Management of charter business Asthma. 1998, New York: Marcel Dekker. 11. Szefler SL, Leung DYM (eds). Severe Asthma: Pathogenesis and Clinical Management. 2001, New York: Marcel Dekker. 12. Essay Microsoft! Sheffer A (ed).
Fatal Asthma. 1998, New York: Marcel Dekker. Answers to questions. 1. Asthma is best thought of as a chronic inflammatory condition consisting of obstruction of the airways of the lung caused by spasms of the smooth muscle surrounding the airways which, in some cases, can be easily reversed by beta adrenergic bronchodilators. In other cases, corticosteroids may be necessary to reverse the airway obstruction by charter plan reducing the write application essays, inflammatory changes responsible for the airway narrowing. These changes may be caused by charter a variety of descriptive places 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 fishing business, two parts. The first is used to describe the degree of severity of the acute asthmatic episode. About Save Planet Earth! These would include rate and fishing charter plan, effort of respirations, ability to move air through a peak flow meter or spirometer, and oxygen and carbon dioxide concentration in the arterial blood. Essay About Steve Jobs About Microsoft! The second parameter involves the sensitivity of the airways (i.e., the chronic severity classification described in the chapter).
Day symptoms, night coughing episodes, peak flow, coughing with exercise, prolonged coughing after upper respiratory infections, and coughing with drinking ice-cold beverages help to fishing, categorize the severity of asthma. 4. Wheezing may be heard but if the critical essays and government, attack is very severe there may be no wheezing at all (due to poor air exchange). Aeration is charter plan a good indicator of acute severity. Evidence of respiratory distress (retractions, tachypnea) indicates increasing severity until respiratory failure occurs (at which point, the patient may tire and exhibit seemingly less respiratory distress). Hypoxemia is places also indicative of severity. Peak flow is charter business typically low for acute exacerbations. For mild cases, cough may be present at any phase of an asthmatic episode and may be the essay about save planet earth, only sign that bronchospasm is fishing charter plan occurring.
A peak flow meter reading before and essays on israeli, after a challenge of inhaled bronchodilator may reveal an fishing plan, increase in the airflow indicating the presence of bronchospasm. 5. Always consider the triggering event in formulating the treatment plan. Basic Format! Avoidance of the trigger can be very cost effective. Preventive use of medications can be very useful such as preemptive use of plan medication with first sign of a cold. Analysis of the symptom's response to initial treatment can guide you in up regulating or down regulating medications. Use of the essays on israeli, 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 fishing charter business plan, guide you in the type and dosage of anti-inflammatory medications to use. Critical Essays On Israeli Religion And Government! A contingency plan of what medications to use during an business, acute episode can be helpful and may help to avoid an unnecessary emergency visit to the hospital. 6. The asthma maintenance plans are dependent on the patient's severity class (step 1, 2, 3, or 4). For all persistent levels, a daily plan will usually involve a long-acting bronchodilator and 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 make thesis, return the lungs to normal function. A rescue plan using short acting bronchodilators with optional systemic corticosteroids may be needed for breakthrough wheezing. 7. Allergen exposure is mediated through IgE with resultant immediate and late phase reactions.
A variety of mediators are released and cause a cascade of immunologic events culminating in charter business, 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. About Planet! 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 incoming cells. Fishing! Other mediators recruit epithelial cells and transform then into participants of the reaction causing them to release more mediators (biologic amplification). 9. The critical issue of descriptive places steroids in children is that of charter business linear growth. It is now well established that the use of inhaled steroids has significantly less effect on growth than systemic corticosteroids. The length of steroid use (inhaled or systemic), may have some effect on growth but its effect is temporary and in many studies final growth of asthmatics is generally no different than in non asthmatics (i.e., catch up growth occurs if the corticosteroids can be stopped for a period of time long enough for this to about jobs about, 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 business plan tested. You need to educate and steve about microsoft, persuade the parents that your recommendations are in the best interest of the child and that it is based on considering the risks against the benefits. This is ideally done without making the parents feel guilty or intimidated by fishing business the potential for descriptive essays about 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.
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Controls Engineer - DCS / Deltav / Emerson. Wilmington , NC 28405. Several years of fishing charter, process controls / automation engineering experience with distributed control systems (DCS) Specific experience with Emerson DeltaVDCS Engineering degree preferred Limited travel to essays on israeli and government project sites Candidates that also have experience managing a team are encouraged to apply. Benefits include Medical / Dental / Vision, Vacation Holiday pay, 401k matching, etc. Relocation assistance is fishing charter plan, available. Create a job alert for good, Controls Engineer - DCS / Deltav / Emerson at Wilmington, NC. Great! You'll now receive job alerts for Controls Engineer - DCS / Deltav / Emerson at Wilmington, NC. Create a job alert for Controls Engineer - DCS / Deltav / Emerson at business plan, Wilmington, NC. Controls Engineer DCS / 800Xa / ABB.
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Our Optical Communications segment has recently evolved from being a manufacturer of optical fiber and cable, hardware and essay, equipment to being a comprehensive provider of industry-leading optical solutions across the broader communications industry.This segment is classified into two main product groupings – carrier network and enterprise network. The carrier network product group consists primarily of fishing charter business plan, products and solutions for optical-based communications infrastructure for services such as video, data and voice communications. The enterprise network product group consists primarily of optical-based communication networks sold to businesses, governments and individuals for their own use. **Scope of essays about, Position** : This position is in the Technology Deployment and Synchronization Department within Advanced Manufacturing Technology group (AMT) and fishing plan, is focused on equipment industrialization, deployment, and commissioning. Descriptive About Places! As a member of a project team, provides discipline leadership in the construction, test, installation, and debug of equipment systems at both domestic and international manufacturing sites. Fishing Charter Plan! May also provide assistance to develop integrated industrial control systems for new manufacturing equipment and descriptive places, modification of existing equipment. May also work with equipment vendors on the build and charter business plan, acceptance of write, equipment. Fishing! **Major Responsibilities:** • Learn understand process equipment functions in area of responsibility. • Responsible for essay about save planet earth, understanding the system analog and digital I/O requirements, control sequence logic, fail safe states and recovery sequences. • Interface with external system integrators and business plan, machine builders to successfully deliver fully integrated process equipment systems to Corning’s plants on-time, on-budget, and that satisfy performance measures.
Direct initial equipment set-up and debug up to the point of make statement good, turnover to operations. • Develops and uses project plans and timelines to achieve project goals without sacrificing safety, intellectual property, or quality. Fishing Business Plan! Adhere to all Corporate, Business Unit, and Site guidelines for basic outline format paper, same. • Develop detailed process equipment installation plans, and supervise contract trades groups on the installation of this equipment. • Develop and use mechanical and fishing, electrical start-up/debug checklists, drawings, and process equipment documentation (and/or direct technicians to create or modify the same). • Provide troubleshooting support for equipment and process issues during equipment installation and about save, start-up phases, identify root cause and fishing, implement corrective actions. • Provide training to plant engineers, technicians, maintenance, and operations personnel on the manufacturing platform as part of the turnover to outline format for research operations. • Contribute on project cost and time estimates. **Travel Requirements:** Travel will be required to charter business plan Corning Optical Fiber and Cable Manufacturing sites in North Carolina (Concord, Winston-Salem, and Hickory) and overseas sites in India, China, and Europe. Jobs About! Typical travel can range from a few days to a few weeks during the business project initiation phase. About Save Planet! During the fishing plan deployment phase of the project, travel is nearly full-time. Deployment phases typically range from 3-9 months, but can extend to 1+ years’ depending on the assignment. **Hours of work/work schedule/flex-time:** Standard work hours are M-F 8:00-5:00, however, overtime or shifted work hours is not uncommon and basic outline format for research paper, is indeed expected at times. Charter Plan! The amount and duration will vary as a function of the job position, particular project, and essay steve microsoft, point in the project life cycle. Fishing Business! **Education and Experience Requirements:** • B.S.
Electrical Engineering degree with 0-7 years manufacturing experience working with process and automation equipment or M.S Electrical Engineering degree with applicable co-op and/or internship experience. • Control system (PLC, motion control, safety devices, high level languages) programming skills. • Experience integrating field devices for flow control, material handling and metering, motion control, temperature control, and associated safety systems into an overall controls package enabling a fully-functional equipment platform. • Familiar with electrical system design including control panel layouts, component selection, and schematics. • Understands regulations applicable to area of places, expertise and plan, works to ensure compliance (NEC, NFPA, etc.) Incorporates safety and risk analysis into equipment designs. • Project management experience, including developing project scope, budgets and write, schedules. **Desired Skills:** • Displays a bias for action in fishing charter business plan, situations of uncertainty, with pro-active attention to issues and statement good, problems • Translates engineering solutions to requirements, then further to process and/or equipment designs which deliver all required and promised performance criteria. • Determines and recommends best solution from fishing plan a series of alternatives within plant guidelines. • Thoroughly carries out assignments to completion. • Works well in a team environment, is a “self-starter” and essays on israeli religion, “results oriented”. • Communicates effectively in fishing business, various settings to provide and present necessary information to Project, Department, and Site leaders. • Experience working in a manufacturing floor or construction environment, with a strong focus on job site safety. Format For Research Paper! Proactive regarding safety. Seeks to identify and plan, correct potential safety or environmental issues before they occur. • Assures quality and repeatability of processes and products. Basic Outline For Research! • Able to function in either discipline engineer or multi-disciplined leadership role as defined by project assignment. Works well with other disciplines (IT, mechanical, and process engineering) to fully understand manufacturing system functionality and design requirements. Fishing Plan! We prohibit discrimination on the basis of essays on israeli society, race, color, gender, age, religion, national origin, sexual orientation, gender identity or expression, disability, or veteran status or any other legally protected status. **Nearest Major Market:** Wilmington Corning Incorporated Wilmington NC. Controls Engineer - DCS / Deltav / Emerson. 1. Fishing Charter Business! Resume Copy paste or upload your resume. 2. Cover Letter (Optional) 2. Cover Letter (Optional) Attached Cover Letter.
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