Turbines Case Essay Example for Free

Turbines Case Essay Definition and historical background Claude Burdin (1788–1873) was the very first person to use the word turbine. The word came from the Latin term turbo/turbines, which means a â€Å"whirling† or a â€Å"vortex.† Burdin used the term to describe the subject matter of an engineering competition being held during that time for a water power source. It would be an oversimplification to describe turbine as a rotating machine that is used to derive power or electricity from the water; a common water wheel may not immediately or necessarily be a turbine, but it definitely is a rotating machine. A more precise definition of a turbine is that it is a machine â€Å"in which the water moves relatively to the surfaces of the machine, as distinguished from machines in which such motion is secondary, as with a cylinder and piston† (Daugherty and Franzini 1965, 213–214). More broadly, to include other types of turbine, it is one of those devices or machines that is being used to channel or convert energy from a stream of fluid (liquid or gas) into mechanical energy which would eventually be used to generate electrical energy, or to support or augment another utility/device. This is done as the stream passes through a system of fixed and moving fanlike blades which causes the latter to rotate. This device (turbine) looks like a large (and sometimes small) wheel with small radiating blades around its rim. The four general classes of turbines are water or hydraulic, wind, steam, and gas turbines. Water or hydraulic, wind, and steam turbines are generally used for the generation of electricity; while the remaining one, gas turbines, is mostly being used in aircrafts (Britannica Concise Encyclopedia 2006). The principal components of simple turbines are the rotor, which in most if not all cases has blades projecting radially from the center to its periphery; the nozzles, where the working jet of fluid is directed and expanded; and blades, where the conversion of kinetic to mechanical energy takes place. Theoretical and operating principles Potential and kinetic energy both exist in a working fluid, which could be compressible or incompressible. Turbines collect this available energy by utilizing any or both of these physical principles: impulse turbines and reaction turbines. Impulse turbines change the direction of flow of a given high velocity fluid jet. The impulse, as a result of this, causes the turbine to spin or rotate, diminishing the kinetic energy of the fluid flow as this is absorbed by the device. In the case of flowing water, it comes available in purely mechanical form (water in nature is one of the most useful and efficient sources of kinetic energy). Scientific calculations show that 1 cubic meter of water can actually produce 9.8 kilojoules of pure mechanical energy for every meter that the volume of water descends. In the same way, a flow of the same volume of water for every second in a fall of 1 meter can provide 9.8 kilowatts, or 13 horsepower. Hydraulic turbines efficiency is estimated at approximately 1, meaning, almost all energy is available or utilized. This kinetic/mechanical energy can be converted to electrical energy with an efficiency of more than 95.0% (Calvert 2004). To get this much power from water, it should be extracted as it is lowered in elevation. The current in a stream, of course, is obvious. This flow comes from the open-channel movement or flow of water as influenced by gravitational forces. Simply put, holding a paddle-wheel in the stream of water will result to the paddle-wheel being rotated and from this outcome, power can be extracted (mechanical energy or electrical energy). This is an example of elementary impulse turbine, a machine acted upon by the impulse or force of moving or flowing water (Calvert 2004). In the case of reaction turbines, torque is developed as a result of fluids pressure or weight. The fluids pressure changes as it goes through the rotor blades of the turbine. There should be a pressure casement so as to contain and maintain the energy of the working fluid as it acts on the turbine stage(s). If there would be no pressure casement, the turbine must be immersed in the fluid flow, such as in the case of wind turbines. It is the casing that directs and contains the working fluid. In the case of water turbines, it maintains the suction which is imparted by the draft tube (Calvert 2004). A simple but very good example for this principle is the lawn sprinkler. In contrast to the impulse turbine, where the pressure change took place in the nozzle, the pressure change in reaction turbines occurs in the runner itself. This happens at the time that the force is exerted, hence, a reaction. Looking at the example of sprinkler, its duty is to spread water coming from it; the resulting energy from the turbine serves to move (rotate) the sprinkler head. Water flows from the center of the sprinkler going radially outward. Water under pressure comes from the center, and then jets of water that can possibly cover the area go out to the ends of the arms of the sprinkler at zero gauge pressure. The significant decrease in pressure takes place in the sprinklers arms. The water is projected at a certain angle to the radius, but it should be noted that the water from a working sprinkler actually moves along a defined radius. The jets of water do not impinge on a runner; but rather, they leave the runner, and this momentum is not converted into force, as opposed to an impulse turbine. The force residing on the runner reacts to the creation of the momentum, hence, the principle itself, reaction turbine (Calvert 2004). In any case, there is no restriction, as far as laws of physics are concerned, for any machine to utilize both principles. Many machines or devices use both of these principles as it is more efficient for the machine to be that way. Different kinds of turbines There are different kinds of turbines used in modern period: the water or hydraulic, steam, gas, and wind turbines. There are other types but these four are the most common and are usually the bases of any other turbines. Hydroelectric power stations utilize water, or hydraulic, turbine to drive their electric generators. Wisconsin, in 1882, witnessed the first of this kind of turbines. The processes taking place in a hydraulic turbine is simple: falling water hits a set of buckets or blades connected to a shaft. This impact will cause the shaft to rotate and move the rotors of the generator. The most common kinds of hydraulic turbine are the Francis turbine, Pelton wheel, and the Kaplan turbine. Two engineers, Sir Charles A. Parsons and Carl G. P. de Laval (of Great Britain and Sweden, respectively), pioneered the building of hydraulic turbines during the late 19th century. Continual developments and improvements of basic machines made hydraulic turbines to be the main power sources utilized to drive most large electric generators (Reynolds 1970). Another kind of turbine is the steam turbine. This is typically consist of conical steel shell that encloses a central shaft wherein a set of bladed disks are placed like washers. These blades are bent and extend outward (radially) from the edge of each disk. Some steam turbines have shafts that are surrounded by a drum wherein the rows of blades are attached. In between each pair of disks, there is a row of stationary vanes that are attached to the steel shell. These extend radially inward. Each set of vanes together with the bladed disk immediately situated/placed beside it constitutes one stage of the steam turbine. Most steam turbines have multistage engines (Columbia Electronic Encyclopedia [Online edition], 2007). Steam turbines are used mostly for electricity generation in thermal power plants, (i.e., plants using fuel oil or coal, or nuclear power). Steam turbines were once used to drive mechanical devices such as in the case of ships propellers. However, most such applications now utilize an intermediate electrical step or reduction gears. Gas turbines are now used mostly for aircraft engines. But there are still some gas turbines being used to drive electric generators (i.e., in an electric–gas turbine locomotive) as well as high-speed tools. The essential components of a gas turbine are (a) compressor, (b) combustion chamber, and (c) turbine that somehow resembles that of a steam turbine (refer to the description in the previous paragraph). The compressor is driven by the turbine, and then provides high-pressure air into the combustion chamber. In this chamber, the high-pressure air is mixed with a fuel and then burned. This makes the high-pressure gas(es) drive the turbine, with the same gas(es) expanding until their pressure decreases and reaches atmospheric pressure (Columbia Electronic Encyclopedia [Online edition], 2007). The last kind of turbine is the wind turbine, which as the name suggests converts the kinetic energy coming from the wind into mechanical and/or electrical energy. If the resulting mechanical energy is directly used by a nearby or even attached machinery (e.g., pump or grinding stones), the turbine device is usually referred to as a windmill. But if this mechanical energy is used to generate electricity, then, the device is called a wind turbine, wind generator, or wind energy converter (WEC; Reynolds 1970). Wind turbines can be three-bladed, two-bladed, or even one-bladed (counterbalanced). Computer-controlled motors point them to the direction of the winds. Danish turbine manufacturers have utilized the three-bladed turbine type. This type of wind turbine has high tip speeds (even reaching up to 6 times the speed of the wind), low torque ripple, and high efficiency, which contributes to the overall good reliability. This type of turbine is the one that is being commercially used to generate electricity. In many cases, the blades are colored in such a way that it blends with the clouds. The length of these blades usually ranges from 20 to 40 meters (or about 70 to 100 feet) or more, while the height is about 200 to 295 feet. Contemporary wind turbine models rotate at a speed of 16.6 rpm (revolution per minute). As a safety precaution to avoid overspeed damage, most wind turbines are equipped with automatic shutdown features during strong winds (Reynolds 1970; Wikipedia, The Free Encyclopedia 2007). There are other kinds of turbines, albeit fewer and smaller ones, in existence. These are the transonic turbines, contra-rotating turbines, statorless turbines, ceramic turbines, and shroudless turbine. Other uses of turbines Almost all electrical energy being used on Earth is generated with any one of the turbines discussed. Turbines with high efficiency can harness approximately 40% of the produced thermal energy, with the rest of the output exhausted as waste heat. Turbines are being utilized by most jet engines to provide mechanical energy from their fuel and working fluid as do most, if not all, power plants and nuclear ships. Reciprocating piston engines (like those found in aircraft engines) can utilize a turbine to drive an intake-air compressor. This configuration is known as the turbocharger (or turbine supercharger) or more colloquially known as â€Å"turbo.† Most turbines are capable of having very high power density the ratio of power to volume, or power to weight. This is due to their ability to function at extremely high speeds (Wikipedia, The Free Encyclopedia 2007). As of yet, no one has established any limitation for this invention of humankind. And with enough research and development, the present capability of these machines can even yield astonishing achievements. Woks Cited Calvert, J. B. â€Å"Turbines.† Date accessed: November 29, 2007 (http://mysite.du.edu/~jcalvert/tech/fluids/turbine.htm). Daugherty, R. L., and J. B. Franzini. Fluid Mechanics. 6th ed. New York: McGraw-Hill, 1965. Reynolds, J. Windmills and Watermills. New York: Praeger, 1970. Strandh, S. A History of the Machine. New York: AW Publishers, 1979. â€Å"Turbine.† Britannica Concise Encyclopedia. Encyclopedia Britannica, Inc., 2006. Date accessed: November 29, 2007 (http://www.answers.com/topic/turbine). â€Å"Turbine.† The Columbia Electronic Encyclopedia. 6th ed. Columbia University Press, 2003. Date accessed: November 29, 2007 (http://www.answers.com/topic/turbine). â€Å"Wind turbine.† Wikipedia, The Free Encyclopedia. Wikimedia Foundation, Inc. Date accessed: November 29, 2007 (http://en.wikipedia.org/w/index.php?title=Wind_turbineoldid=173495357).

Role of the nurse Essay Example for Free

Role of the nurse Essay The nurses in the Capulets household is the superior to that of a normal servant. Juliet seems to have taken the place of the daughter she once had and everything she does, she does for Juliets benefit. She is bossy with the other servants, knowing she has a special place in the family. She is a simple soul who is an easy target for Mercutios lewd ribbing. She is long-winded as well as rather rude and bawdy, but she seems sincere and makes the audience laugh with her rather than at her. As the story develops she becomes more and more a part of the conventional world that opposes and fails to understand the passion of Romeo and Juliet for each other. In the play, the Nurse serves as a mother figure to Juliet. She is a confidant, advisor and helper to Juliet. It is her relationship with Juliet that gives importance to her role in the play. The Nurse was the one who revealed to both Romeo and Juliet the identities of each other i.e. that Romeo was a Montague and Juliet a Capulet. She was also the go-between for Juliet and Romeo, delivering messages and notes from one to another. Thus, she played a key role in bringing about their marriage and its consummation. Not only does she contribute heavily the plot, the Nurse is also vital in the area of characterization. Her vulgarity and pragmatic views of love and marriage are in stark contrast to Juliets purity and passion. This emphasizes the pure and sacrificial love between Romeo and Juliet. The Nurses advise to marry Paris and give up Romeo also showed us the change in Juliet when she held fast to her love for Romeo and called the Nurse a wicked fiend for her hypocritical behaviour. The Nurse is a complex character with many sides to her personality. She displays both attractive and repulsive qualities at the same time. Firstly, it is obvious that she is genuinely fond of Juliet. This can be seen from her loving reminisces of Juliets childhood and her affectionate  calling of Juliet by names such as lamb and child. Also, she teasingly finds excuses to increase Juliets impatience for news of Romeo by talking about her various aches and pains. She acts as a go-between for Romeo and Juliet, carrying messages back and forth for the two lovers and does what they ask her to do for them. For example, she helps Juliet find out news about Romeo, and she helps Romeo procure a rope ladder. She also refuses to accept Romeos gift of money for these services at first, indicating her willingness to serve her mistress. This love for her young mistress naturally leads her to become protective of Juliet. She warns Romeo not to lead Juliet into a fools paradise, for that would be a gross kind of behaviour. Also, she wishes that she could see Juliet marry well. [Act I Scene III] When Capulet scolds Juliet for refusing to marry Paris, the Nurse speaks up for Juliet, saying that Capulet is to blame for rating her so, and that he should not scold her so badly. The Nurse sometimes speaks so much that even Lady Capulet has to tell her to keep quiet. This shows that she can be irritating at times and is also a gossip. She is also boastful, and claims all credit for Juliets upbringing. Her views of love and marriage differ greatly from Juliets. She advises Juliet that it best you married with the County because she thinks that Juliet will be happier in her second match. Your first is dead, or t were as good he were, As living here, and you no use of him Thus revealing that she does not believe in faithful and romantic love. She is also rather bossy with the other servants, ordering Peter around, because of her close association with Juliet and her parents. My fan, Peter. Ah, wheres my man? Give me some aqua-vitae. The Nurse is also fickle. Once she hears of Romeos banishment, she advises Juliet to marry Paris, comparing Romeo to him and pointing out his flaws. O, hes a lovely gentleman! Romeos a dishclout to him Although this could be viewed as practical, yet it is a violent contrast to her earlier praising of Romeo and comes across as being rather hypocritical, as Juliet observed in the lines, O most wicked fiend! To dispraise my lord with that same tongue Which she hath praised him with above compare So many thousand times! The Nurse does not seem to have got too carried away with the situation, but is eager for Juliet to marry. She offers no advice or caution to what Juliet should be doing, although she clearly knows that Juliet is young and inexperienced. She also makes no effort to suggest that this will be a problem. Like Friar Laurence, she goes behind her employers backs, acting as Romeo and Juliets messenger, such as when she is asked by Juliet to discover Romeos identity. At first the Nurse admires Romeo, Why hes a man of wax (Act 1 Scene 3), but warns him not to lead Juliet into a fools paradise (Act 2 Scene 4), probably mostly because Juliet is still very young and naà ¯ve. After Tybalts death, the nurse turns against Romeo Will you speak well of  him that killed your cousin (Act 3 Scene 2), Shame come to Romeo (Act 3 Scene 2). Finally, when Juliet needs the Nurse most Comfort me, council me when her parents tell her that she must marry Paris, the Nurse disappoints her by simply telling her that it would be better to marry someone to support her. Why does the Nurse fail as an advisor to Juliet? Although the Nurse genuinely loves and cares for Juliet, yet she does not understand the love and passion Juliet has for Romeo. The Nurse, unlike Juliet, is vulgar in nature and views of love and hence cannot comprehend why Juliet prefers Romeo to Paris. The Nurse advises Juliet to marry Paris, a very eligible and wealthy bachelor, as she does not believe in loyal and faithful love. Thus, she loses Juliets love and trust and Juliet does not confide in her Friar Lawrences plan to drink the potion. Hence, the Nurse is unsuccessful in protecting and caring for Juliet due to her lack of understanding, indirectly bringing about the final tragedy of her death. Romeo and Juliet, is a story of two young lovers whose love was destined for destruction. They did not imagine that their love would lead to the tragedies that it did. These two young people did nothing wrong except fall in love. Three aspects of their destruction included the feud between the two families, the nurse and her betrayal of Juliet and the most important aspect of all is fate.

Nebulized L-epinephrine in Post -Bronchoscopy Croup

Nebulized L-epinephrine in Post -Bronchoscopy Croup Safety and Efficacy of Nebulized L-epinephrine in Post -Bronchoscopy Croup in Children, Anesthesia Consideration Dr Asma Aref Idamat, Pharmacist Dr Hussein Khraysha, Senior Specialist Anesthetist Dr Najeh Alomari, Consultant Pediatric Surgeon Amman-Jordan ABSTRACT OBJECTIVE: To assess the value of bronchodilator effect of nebulized epinephrine post bronchoscopy in children and to compare the effectiveness and side effects of nebulized L-epinephrine (NLE) 1/1000 at a dose of 0.1 mL/kg versus 0.5 mL/kg in the treatment of post-bronchoscopy croup and upper airway obstruction . MATERIAL AND METHOD: Between April1998 and April 2002, 120 children, who developed signs and symptoms of upper airway obstruction (UAO) after bronchoscopy, were randomized to receive either 0.1 mL/kg or 0.5 mL/kg of nebulized L-epinephrine (NLE). Age group ranged from 4months to 14 years, mean of 4.6 years, male /female ratio 4:1. UAO scores, vital signs (VS) ,oxygen saturation (O2 Sat)and side effects if present were recorded before ,at 15 minutes , 35 minutes and 45 minutes after the treatment. The treatment was accomplished in the recovery room under the care of the anesthetist and pediatric surgeon. All patients were reviewed carefully prior to discharge from recovery room. RESULTS: Sixty children were allocated to the 0.1mL/kg (NLE) and sixty children to the 0.5 mL/kg (NLE).. The (NLE) was mixed with 2ml of normal saline. Both groups showed improvements in UAO scores and Oxygen saturation over time. There were no significant differences in UAO scores and VS between the groups at all time points. There were no side effects of epinephrine during the observation. CONCLUSION: The administration of nebulized L-epinephrine is safe and effective in reliving croup and upper airway obstruction (UAO) post-bronchoscopy in children. NLE at the dose of 0.1 mL/kg results in similar improvements in the UAO scores, compared with the dose of 0.5 mL/kg. No complications were seen in either dose and we recommend the routine use of 0.1ml/kg (NLE) post –bronchoscopy in children. Key words: Bronchoscopy, Bronchodilators, L-adrenaline, croup, children Introduction Croup or subglottic edema post bronchoscopy and post intubation is a well known entity. Children are more vulnerable to develop croup after such procedures than adults due to well known differences in the anatomy of upper airway and tracheo-bronchial tree with narrower laryngeal and tracheal lumens with the result of obstruction more readily by to mucosal edema due to different causes, like viral and bacterial infections as well as allergic manifestations. The narrowest part of upper airway is that at the level of cricoid cartilage which makes the internal tracheal injury by endo tracheal tube or bronchoscope sheath more prone at the narrow subglottic area even after easily passage through the vocal cords. Bronchoscopic removal of aspirated foreign bodies in children is a common procedure in Jordan and many other countries worldwide. The procedure is performed under general anesthesia using rigid bronchoscopic device through which the ventilation is maintained. Foreign bodies are usu ally successfully removed using forceps, wash out with saline and suction tube. In many cases repeated bronchoscopic intubation may be necessary to assure complete removal of foreign bodies with the result of significant irritation and edema to the tracheo-bronchial tree with the sequel of croup, wheezy chest and features of upper airway obstruction (UAO) which may lead to significant morbidity and prolonged hospitalization. The incidence of post intubation croup in children was reported to be between 1 to 6 % (1,2). The medical treatment of postintubation croup is the same as that for infectious croup, including corticosteroids and nebulized epinephrine. The vasoconstrictive effect of epinephrine decreases the degree of subglottic edema, resulting in clinical improvement. Traditionally recemic epinephrine has been used as a non-selective adrenergic agonist of choice in children due to its supposedly fewer side effects than the more active and more readily available natural laevorot atory form of epinephrine. However, there seems to be no pharmacological basis for this belief (3-5) and subsequent trials have shown the L-epinephrine which we use for resuscitation, to be safe and effective in both infectious and postintubation croup(6,7). In addition, L-epinephrine is readily available in all countries while racemic epinephrine is not. Even in countries where both forms are available the racemic form is much more expensive(8 ).It was noted that the doses of L-epinephrine used in those trials were 2.5 and 5 mL of 1:1000 solution for all recruited children, regardless of weight. As a result, the dose of L-epinephrine in the treatment of croup has been suggested to be 0.5 mL/kg, with a maximum dose of 2.5 mL and 5 mL for children younger and older than 4 years, respectively (9). So far there have been very few reports that have studied the efficacy L- epinephrine in the management of post bronchoscpy croup and (UAO) in children. This study was designed for tow purpo ses of: (a) ascertaining the effectiveness of L-epinephrine in the management of croup and weezy chest post bronchoscpy in children or not; and (b) comparing the efficacy of a nebulized L-epinephrine at the dose of 0.1ml/kg versus 0.5ml/kg for the treatment of the above conditions and finally to recommend the routine use of L-epinephrine at the dose of 0.1ml/kg as protocole for the management croup and (UAO) post bronchoscopy in Children Material and Methods Between April1998 and April 2002, 120 children, who developed signs and symptoms of upper airway obstruction (UAO) after bronchoscopy such as severe irritative cough, wheezy chest, stridor and hoarseness of voice were randomized to receive either 0.1 mL/kg or 0.5 mL/kg of nebulized L-epinephrine (NLE) with maximum of 2mL for patients below 5 years of age and 4mL for patients above 5 years of age. Two mL of normal saline were added to the dose of L-epinephrine. Age group ranged from 4months to 14 years, mean of 4.6 years, male /female ratio 4:1. We used L-epinephrine because racemic epinephrine in not available in our hospital and it is expensive. The treatment was accomplished in the recovery room under the care of the anesthetist and pediatric surgeon using facemask with 100% oxygen at 6 liters/minute. The main parameter that evaluated was the change of the (UAO) scores (Table 1) and the other parameters that evaluated were changes in the respiratory rate, heart rate, blood pressure and oxygen saturation observed by pulse oxymeter. All parameters were evaluated at 15 minutes, 35 minutes and 45 minutes after the treatment, side effects of nebulized epinephrine, if present such as tremor, arrhythmia, and pallor were recorded at the same time. The management was repeated after 2 hours whenever clinically indicated if the results were not satisfactory. All patients were reviewed carefully prior to discharge from recovery room. RESULTS One hundred and twenty children post bronchoscopy for foreign body aspiration (FBA) were enrolled in this study. Sixty children were allocated to the 0.1mg/kg (NLE) and sixty children to the 0.5 mL/kg (NLE). The (NLE) was mixed with 2ml of normal saline. Both groups had the same baseline characteristics (Table 2) and both groups had initially moderate upper airway obstruction. Both groups showed clinically significant improvements and reduction in UAO scores and Oxygen saturation at 15, 35 and 45 minutes(Table 3) compared to that prior to (NLE) at time 0. There were no significant differences in UAO scores and VS between the groups at all time points and none required immediate intubation or re-bronchoscopy. Side effects of epinephrine including pallor, arrhythmia and tremor were not observed. Table 1: Upper airway obstruction score (15)** Score 0 1 2 Cough Stridor Retraction Inspiratory breath sounds Cyanosis* None None None Normal None Hoarse cry Inspiratory Suprasternal Harsh with rhonchi In room air Bark Inspiratory +expiratory Suprasternal+ substernal +intercostal Delayed In 40% oxygen *Cyanosis was modified and defined as oxygen saturation ** Downes JJ, Raphaely RC. Pediatric intensive care. Anesthesiology 1975; 43: 238-50. Table 2: Patient characteristics of our study groups 0.1mL/kg 0.5mL/kg Number of patients 60 60 Mean age (years) 3.4 5.8 Gender (M/F ratio) 4:1 4:1 UAO score immediately after bronchoscopy ( Mild ( Moderate 4-7) n, % (Severe > 7) n, % 12 (20%) 42 (70%) 6 (10%) 15 (25%) 38 (63.33%) 7 (11.66%) Table 3: The outcome variables in our study groups Time Time 0 15 Minutes 35 Minutes Nebulized L-epinephrine / Dose Number of patients 0.1mL/kg 0.5mL/kg 60 60 0.1mL/kg 0.5mL/kg 60 60 0.1mL/kg 0.5mL/kg 60 60 Upper airway obstruction score (Mean) 5 (1-8) 5 (1-7) 3 (1-6) 2 (0-5) 2 (0-5) 1.4 (0-5) Respiratory rate/minute (Mean) 28 30 32 33 29 28 Heart rate /minute (Mean) 126 128 130 128 125 123 Systolic blood pressure :mmHg (Mean) 95 100 102 106 97 103 Diastolic blood pressure: mmHg (Mean) 55 61 58 63 56 62 Oxygen saturation % (Mean) 93 94 96 97 98 98 Discussion Post bronchoscopy croup and respiratory distress is know entity in pediatric age group, especially when there is a need for repeated bronchoscopic trials for retrieval of long standing foreign bodies. In such conditions, severe inflammatory process of tracheo-bronchial tree is almost present from certain foreign bodies like peanut and other seeds that elaborate severe irritative substances leading to infection and granulation of bronchial tree that aggravate the respiratory distress, bronchospasm and croup post bronchoscopy. The main aim of the clinician in such conditions is to provide relief of respiratory distress by decreasing upper airway irritation and improving air entry. The present study has attempted to verify the safety and efficacy of bronchodilator effect of (NLE) and to prove that a dose of 0.1mL/kg is at least as effective as the dose of 0.5mL/kg in the treatment of croup and (UAO) post bronchoscopy in children. Many studies have tested the value of racemic epinephrine compared to placebo (10) and to nebulized salbutamol (11-13) and the results showed superior value of racemic epinephrine in the treatment of bronchiolitis. It seems no pharmacological basis for the belief that racemic epinephrine is safer than L-epinephrine (3-5) and racemic epinephrine is not available in Jordan and is thus difficult to obtain and expensive, making L-epinephrine a more viable option. Sumboonnanonda (14) used (NLE) at the dose 0.05mL/kg (maximum 0.5mL) in the treatment of infectious croup. They found a clinically significant improvement in (UAO) scores at 24 and 48 hours after admission, even in the placebo group without dexamethasone treatment .The present study found similar results at average 30 minutes in children with post-bronchoscopy croup and wheezy chest. The maximum dose of (NLE) in this study was 2mL for patients less than 5 years of age and 4mL for patients more than 5 years. In our study we confirmed the safety and efficacy of (NLE) in the treatment o f post intubation croup (6) and infectious croup (7), when Nutman (6) used 0.25mL of 1% L-epinephrine (2.5mg) regardless the weight, for children post-intubation croup and found significant reduction of stridor score within 20 minutes, the same we observed in our study which continued at least over the next 4 hours post –bronchoscopy. Waisman (7) used 5mL of 1/1000 L-epinephrine (5mg), regardless the weight, in children with infectious croup when he found a significant reduction of croup score, reaching its maximum at 30 minutes. The majority of our patients required one section of (NLE) to achieve these results and in very few of them who had long standing foreign bodies and repeated trials of bronchoscopy and bronchial wash out, another session of (NLE) required over 24 hours on 6 hourly interval. The present results suggest that nebulized L-epinephrine, at a minimal dose of 0.1 mL/kg, is at least as effective as the dose of 0.5 mL/kg in the treatment of post-bronchoscopy c roup. Both doses temporarily alleviated airway obstruction without undesirable side effects. The dose of 0.1 mL/kg is much less expensive. We would suggest that the dose of 0.1 mL/kg is also efficacious in the treatment of children with post-bronchoscopy croup. This dose may be adequate to diminish mucosal edema of the upper airway by stimulating alpha-adrenergic receptors and producing vasoconstriction (4). In conclusion, the presented data suggest that administration (NLE), at the dose of 0.1 mL/kg is safe and effective and results in a similar reduction in upper airway obstruction scores, compared with the dose of 0.5 mL/kg, in children with post-bronchoscopy croup. Neither dose was associated with any adverse side effects and we recommend the routine use of 0.1mL/kg (NLE) post –bronchoscopy in children. Taking in consideration the comparable efficacy of both doses, the use of a small dose in clinical practice would save the medication expense and, theoretically, have a lower risk of developing side effects that are mostly dose dependent. Future studies should consider the use of (NLE) at the dose of 0.1 mL/kg in children with post bronchoscopy croup, which has a pathophysiology resembling infectious croup. Further studies examining the optimal dose and frequency of (NLE) in children with croup due to different pathologies including post-bronchoscopy croup seem warranted. Acknowledgment to DR Mohamad Al-Sukar, Chair of Anesthesia Department –Royal Medical Services,Dr Kassem Khamaeseh,MD, Anesthesia Intensive care for their support and review of this manuscript. References 1. Borland LM, Colligan J, Brandom B.W. J Clin Anesthesia Koba BV, Jeon IS, Andre JM, MacKay I, Smith RM. Postintubation croup in children. Anesth Analg 1977; 56:501-5 Holbrook PR, Issues in airway management -1988. Critical Care Clin 1988;4:789-802 Remington S, Meakin G. Nebulized adrenaline 1/1000 in the treatment of croup. Anesthesia 1986;41:923-946 Tabachilk E, Livensopn H. Clinical application of aerosols in pediatrics. Am Rev Respir Dis 1988;122:97-103 Waisman Y, Klein BL, Boeinning DA, Young GM, Chamberlain JM, O’Donnell R, et al . Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosol in the treatment of laryngotracheitis (croup). Pediatrics 1992;89:302-6 Nutman J, Brooks LJ, Deakin KM, Baldesare KK, Witte MK, Reed MD. Racemic versus L-epinephrine aerosol in the treatment of postextubation laryngeal edema : Results from a prospective ,randomized double-blind study .Crit Care Med 1994;22:1591-4 Menon K, Sutcliffe T, Klassen TP. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995;126:1004-1007 Siberry GK, Lannone R. The Harriet Lane Handbook 15th Edition .St Louis : Mosby-Year book,2000:705-6 Kristjansson S, Lodrup KC, Wennegren G, Strannegard I-L, Carlsen KH. Nebulized racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers. Arch Dis Child 1993;69:650-54 Wennegren G, Holmgren D, Engstrom I, Sten G, Bjure J. Using transcutaneous blood gases to evaluate treatment effects on acute asthma in young children. Scand J Clin Lab Invest 1988;48(supp 189:41-44 Sanchez I, Dekoster J, Powell RE, Walstein R, Chernik V, Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infant with bronchiolitis . J Pediatr 1993;122:145-151 Reijonen T, Korpi M, Pitkakangas S, Tehhola S, Kyllikki R. The clinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis. Arch Pediatr Adolosc Med 1995;149:686-692 Sumboonnanonda A, Suwanjutha S, Sirinavin S. Randomized controlled trial of dexamethasone in infectious croup. J Med Assoc Thai 1997;80:262-5 Downes JJ, Raphaely RC. Pediatric intensive care. Anesthesiology 1975; 43: 238-50.

The Jewish Community in Greece Essay -- Judaism Religion Papers

The Jewish Community in Greece Problems with format ?The Jewish community in Greece has a very colorful and intriguing past, but it is also a history filled with undeserved discriminatory acts and hatred.? The earliest Jews came to Greece either in chains or because of persecution, and soon experienced more hardships and troubles.? And just when Greece had overcome its discrimination and its Jews began to breathe easily, the worst persecution of all befell the community.? The Jewish community in Greece was once large and prominent.? In fact, ?the country once boasted some of the most distinguished and ancient Jewish communities in the world.1 But only a shadow of its once glorious past remains, and Jews are currently facing discrimination today.? The best example of Greek Jewry is the city of Thessaloniki, which exemplifies the shifting community throughout history.? Greek Jews are still facing discrimination, but hopefully, Greek sentiment will change. Greek Jews Throughout History ?Scholars are unsure when Jews first settled on the Greek isles, but most agree the earliest were slaves ?forcibly transported to Greece by way of Cyprus, Ionia, and the Greek isles by various enemies of Judah during the biblical period.?2? Jews came in waves to Greece, usually sold into slavery during wars, such as the Hasmonean War and the Maccabean Wars.? Later, when Rome conquered Asia, even more Jews came to Greece to escape Roman rule, and their numbers continued to increase.? Erich Kahler believes that this is just one reason why the number of Jews in Greece increased so steadily.? The other explanation is ?that Judaism was the first proselytizing religion, the first religion with a mission not only for its own tribe, but fo... ...aughtered Jews. The Times Higher Education Supplement? iss. 1241 (Aug. 16 1996):? 18. Murphy, Brian.? ?Israel Complains About Greek Composer?s ?Anti-Semitic? Comments. Associated Press Worldstream.? 12 Nov. 2003, International News. ?State Department Backs US Envoy to Greece in Spat with Athens. Agence France Presse.? 14 Nov. 2003, Domestic. ?Vandals Attack Jewish Site in Northern Greece. Associated Press Worldstream, 9 Oct. 2003, International News. ?Vandals Spray Holocaust Monument in Greece. Agence France Presse, 9 Oct. 2003, International News. Varouhakis, Miron.? ?Jewish Group Issues Olympic Threat Over Suicide Bombings Exhibit. Associated Press Worldstream.? 9 Oct. 2003, International News. ?Wiesenthal Center Urges Jews to Avoid ?Xenophobic? Greece Before Olympics. Associated Press Worldstream.? 20 Nov. 2003, International News.

Sprite :: GCSE Business Marketing Coursework

Sprite â€Å"Image is Everything† â€Å"Thirst is Everything, Image is Nothing† we have all seen this slogan slapped on to every one of Sprite’s products for last couple of months. But what does it mean? Does it mean that someone at a Pepsi convention should order a Sprite, a Coke product, just cause they like the taste? Of course not, cause if they did they would get kicked out at the very least. Advertisers use this sort of slogan to catch your attention, and then they have you right where they want. In the most recent Sprite commercials that feature Grant Hill of the Detroit Pistons, they show us that the reason why we would have a Sprite is just for the taste of it. But if this was all they are trying to get across to us wouldn’t it be cheaper and wiser to use a 6 dollar per hour kid rather than a guy that won’t step foot in a place for less that a 100 grand. Why would they make a commercial that contradicts itself? The reason an advertisement would contradict itself like thi s is for one reason only, to try and fool our wants and desires into becoming our needs. Our needs are simply something that is a necessity for us to survive, such as food and water. We all know we couldn’t go long without these simple yet essential things. While our wants and desires for things such as five star restaurants and luxury cars. Which by no means are needed to survive, but just make living all the more fun. Advertisers are masters on how to exploit our desires, and to make us believe that they are our needs. And it is by no means is this easy or cheap for a commercial to be able to do. To be able to make us believe that our life would, in some way, be better with this product by our side. Sprite’s commercial that plays every time you blindly surf the television channels are all about image. The commercial that is shown the most, features Grant Hill drinking a Sprite. While they state in the back round and print on the screen, â€Å"Thirst Is Everything, Image Is Nothing†. When I first saw this I was thinking, â€Å"cool a great drink that anyone can have and not look out of place†.

Challenges of Living with Diabetes Essays -- Health Medicine

A long-term health condition can also be referred to as a ‘chronic illness’ and it can be used to define recurring conditions such as asthma, arthritis, and diabetes. When living with a long-term health condition it can for some people present them with many new challenges. Not only does it take time for them to adapt and accept their illness but also they may feel affected not just physically, but psychologically, culturally, and sometimes even personally such as financial or relationships with family and friends. In this essay, I will examine in turn the main challenges people with diabetes face. Sometimes with diabetes, a person may feel an array of emotions when their illness has been diagnosed this can vary from being confused, and anxious about their health and future, to feeling resentment and frustration with their own bodies. It is also common that many people who have long-term health conditions can also be susceptible to depression and stress when attempting to deal with the aspects of their illness, such as being reliant on insulin injections or having to take care about what they eat and drink. As explained in an article by W.H Polonsky. (K101, Resources 3, pg19 ) Many individuals may feel as if they have lost control of their everyday routines, or are somewhat defeated when following treatments programmes and not being able to see an improvement in health. Recently healthcare professionals recognized that if they provide patients with well-defined, straightforward information and knowledge about their illness, it could encourage people to take more of an involved role in managing their condition, such as setting achievable goals, or becoming better practiced at monitoring and managing insulin levels. Thi... ...e boundaries of the physical situation but also that of their psychological status too. Works Cited Lawton, J., Ahmad, N., Hanna, L., Douglas, M. (2006) ‘Pakistani and Indian patient’s experience of Scottish diabetes services: a qualitative study.’ In: K101 An introduction to health and social care, resources, Block 2, pg. 15, Milton Keynes, The open university. NHS, (2010) Diabetes NHS choices, Available: http://www.nhs.uk/conditions/diabetes/pages/diabetes.aspx. Last accessed 4th Nov 2010. Polonsky, W.H (2006). ’Encouraging effective self-management in diabetes.’ In: k101 An introduction to health and social care, resources, Block 3, pg19, Milton Keynes, The open university. The open university (2008) K101 An introduction to health and social care, block 1, unit 2, Illness, health and care, pg. 84, Milton Keynes, The open university.

Tadao Ando

Tadao Ando GA Architecture 12 VOL. 2 1988-1993 This book talks about Tadao Ando’s projects in a chronological order, the publication mainly works with photographs and overview drawings, but they have a lack of detail drawings and some landscape sketches.His designs have this very specific style that is unique in a different sense than his western colleagues, his raw usage of concrete in the 90is a very clear architectural language that was only beginning to develop with other practices. He has a dialogue between everything that surrounded his projects, he liked the idea of having open spaces for people to gather around to chat, talk or even better exchange opinions or ideas like the plazas in the ancient Greeks.His way of dialogue is not easy to understand cause of the variety he always includes with opposites or â€Å"extremes† such as light/shadow, East/West or the colors given by the nature these can only be felted or seen for the human but he had other ways of dialo gue that would be nature with people, architecture with nature, people with architecture, people with people and it could also be with himself like a way of conscience.This architect never cared about the size of his projects they could be a 4Ãâ€"4 house or a huge museum in a far away forest, the only thing he cared about was to synchronize the harmony for every living thing or object (in this case his architectures) inside or outside the structure to live together in peace and for the humanity to enjoy the spaces given to them. One of my favorite works in this book is the Miyashita House in Kobe, Hyogo.This house has three stories all of them organized with different purposes, a studio and master room are in the lower ground, middle section has the dining room where it has a beautiful well-made spiral staircase leading up to a bedroom and continues up to an astronomical observatory, I think this idea is amazing having a house like this to enjoy yourself the wonders of the sky.This structure is rectangular with a semi triangle on its side, it has lots of opened space and huge windows for the sunlight to light up inside, all the walls are made of reinforced concrete masonry and this architecture is surrounded by nature with an incredible view overlooking West Kobe and the Inland sea of Japan.