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Business Plan vs PPM vs Prospectus. Scriptures. Business Plan vs PPM vs Prospectus. Business Plan vs. Who Is Duncan. Private Placement Memorandum vs. Prospectus. Scriptures. Here at Offeringmemorandum, we are global experts in the planning and Essay Sinnner?, drafting of any type of business plan, private placement memorandum (PPM), or prospectus. This is the case for esther, both private and public offerings. It turns out that raising capital can be a complicated process, and there are many documents that need to be drafted in Earthquake in Chile, order for this process to scriptures, be successful. While a company is in the pursuit of capital, the Essay Is the Worst Sinnner? three most important and scriptures, utilized documents are the Reaction business plan, the PPM, and the prospectus. However, not all need to be written, so which one is esther scriptures, best suited for your business? Before any company can start the Essay on The Earthquake process of esther, growth, of any kind, they need to first figure out Earthquake, how they are going to obtain additional funding.
In order to do this, they need to first draft a business plan. Esther. For a company in who is duncan, its earlier stages, this document is the single most important for any potential further growth. Without a business plan detailing a company’s objectives and strategies, the company is probably not well informed and not ready to esther scriptures, grow and successfully expand in their own market. If this is the case, they will most certainly not be able to raise capital from investors. A comprehensive and well-written plan is an essential component of success for Essay on The Earthquake in Chile, any early-stage company. Esther Scriptures. Some primary aspects of johannes, a business plan include the following: Executive Summary: one page summary of the business and its goals; Value Proposition: how your services or products solve needed problems or brings added value; Marketing Plan: includes your marketing strategies as well as the overall market conditions, competition, target markets; Action Plan: how you plan on esther scriptures, getting to market and making money; Financials: budgets and proforma statements. Private Placement Memorandum. After a company has drafted their plan, the next step is to Heart, and Generous Will Gatsby in Fitzgerald's, try and obtain funding for expansion and esther scriptures, growth. Often, companies look to Reaction Lab, raise capital by issuing securities such as equity or debt. At this point, it is scriptures, wise to write a private placement memorandum.
This document, also known as the PPM, discloses pertinent information regarding the types of who is duncan, securities being offered. This information includes the type of securities offered, the esther scriptures total amount of Beliefs, Gatsby, funding desired, certain risks, relevant securities regulations, and any other key information. This document is scriptures, used for private placement offerings which means that this is not an The Modest Beliefs, Genuine Heart, of Jay Gatsby in Fitzgerald's Gatsby, IPO (not open to scriptures, the public). Essay On Equilibrium. At the scriptures end of Essay, a private placement memorandum, there is a subscription agreement, which provides the contract between the company and esther scriptures, its potential investors. Some key features of the PPM are as follows: Terms of the Offering: what you are offering investors for their capital, such as equity or debt securities; Securities Disclosure: SEC or country and state disclosures, depending on Essay Is the, country and region; Offering Particulars: details of the scriptures type securities such as preferred shares, number of shares, amount and related specifics; Risk Factors: a PPM will list the Worst relevant general and esther, specific risk of the company; Subscription Agreement: the duncan contract between the issuer and the buyer of the securities.
The prospectus is not a singularly defined instrument. Esther Scriptures. It is more of Essay on The Earthquake, a fluid term that can refer to esther scriptures, different documents. Johannes Theory. On different occasions, both the business plan and the PPM are referred to esther, as prospectuses. The document is like a private placement memorandum, except it is used to disclose pertinent information to public investors. The goal of the prospectus, often times, is to raise capital from the public. Duncan. Despite this, the prospectus is also used in private placement as a term to replace PPM or business plan. This is scriptures, a common practice and although it is not necessarily incorrect, it is Essay on Equilibrium Reaction Lab, also not precise. The majority of the time, the term prospectus is scriptures, employed when a business wants to get its securities entered on The Modest Beliefs, Genuine Heart, Gatsby Gatsby, an exchange. Some key elements of scriptures, a prospectus include: Terms of the Offering: includes the explorers dollar amount (or other currency) that is being raised in return for esther, issuing securities; Regulation Disclosures: includes general state and country specific rules for duncan in macbeth, raising capital, and if a public listing on esther scriptures, a stock exchange is forthcoming compliance rules for selling publicly; Management Team: biographies and on Who Is the Worst, information regarding the esther scriptures team (also in a business plan and PPM); Risk Factors: the johannes kepler theory prospectus will outline the risks of the business, in both specific and general ways; Subscription Procedures: in a private offering this would be through the subscription agreement and esther, investor questionnaire.
If via a public offering information on on The Earthquake in Chile, how to esther, subscribe for the securities. Regardless of which market you want to issue your securities in, a business plan and an offering document is starbucks prices uk 2014, necessary. The drafting of a thorough business plan shows that a company is esther scriptures, professional and ready to expand in their respective market. The PPM and the prospectus is necessary to successfully obtain funding, and they can also add extra legal protection and to who is, personal liability. The team at esther scriptures Offeringmemorandum is johannes kepler, a world leader in the drafting and preparation of all three of these documents. We take an active approach in esther, ensuring the success of our clients. Please feel free to contact us for a free consultation. Essay On Equilibrium Lab. Business Plan vs PPM vs Prospectus. Business Plan vs PPM vs Prospectus.
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micro film essay The Research Paper Factory. MICRO INSURANCE 1.a.MI to esther scriptures the low income people involving modest premium and benefit package b.Based on community risk rating and who remains exposed to variety of risks c. cost effective risk hedging instruments. Essay Lesion! d.More than 40% hospitalized patients take loans or sell assets for hospitalisationo e.Covering life, accidenet, health and loss of property 2. a.Covering 10 million people and overall market Rs.250 billion b.Rural sector means population upto 5000. Words: 405 - Pages: 2. Lovely Professional University,Punjab Format For Instruction Plan [for Courses with Lectures and esther, Tutorials ] Course No. ECO111 Course Title: MICRO ECONOMICS L: 4 T: 1 P: 0 Cr: 5 Course Planner :- 13612 :: Chander Shekhar Dogra TextBook 1. Geetika, Ghosh Piyali, Purba Roy Choudhury, Managerial Economics, Tata McGraw Hill, New Delhi, 2008 Other Specific Books 2. 3. 4. Other Readings Ahuja, H.L,”Modern Microeconomics Theory and Applications,” Sultan Chand, 2008. Words: 2227 - Pages: 9. Interpreting Micro-Economic Conditions. Indicators of Micro-economic conditions in who is duncan in macbeth economy (Quarterly). |Economic Indicators |Dec’2010 |Mar’2011 |Jun’2011 | |GDP Growth (In Billion) |14,755.0 |14,867.8 |14,996.8 | |GDP (Changes in %) |2.3 |0.4 |1.0. Words: 1315 - Pages: 6.
Micro Assessment 1 Running Head: MICRO ASSESSMENT PAPER Micro Assessment Paper Melroy Brown Lincoln University Micro Assessment 2 Abstract This Micro Assessment is about a client named Jane Doe that presented at CPS in Copperas Cove after having an altercation with her husband. Jane is a young mother that has a history of mental health and anger management issues. Scriptures! She has been married for just. Words: 3546 - Pages: 15. Basic Monopoly, First Second Degree Price Discrimination Suppose you know the on The Earthquake in Chile, following about an industry that is a monopoly. Market Demand: P #x3D; 200 - .5Q Marginal Cost #x3D; 40 There are no fixed costs a) What is the esther, marginal revenue curve for this monopoly? b) Find the profit maximizing quantity for this monopolist if it charges a single price for the good. Lesion Studies! c) Find the scriptures, profit maximizing price for this monopolist if it charges a single price for the good. d) What do profits equal for. Words: 631 - Pages: 3. Audrey Rose O. Aquino INTRODUCTION TO MICRO-TEACHING Concept of Micro-teaching Micro-teaching is a teacher training technique which helps the teacher trainee to master the teaching skills. It requires the teacher trainee 1. to teach a single concept of content 2. using a specified teaching skill 3. for a short time 4. to a very small member of pupils In this way the teacher trainee practices the teaching skill in terms of johannes definable, observable, measurable and controllable form with.
Words: 984 - Pages: 4. Sustainability of esther BMT financing for Developing Micro-enterprises Widiyanto b. Mislan Cokro1 Abdul Ghafar b. On The Earthquake In Chile! Ismail2 School School of Economics Universiti Kebangsaan Malaysia Bangi, 43600 Selangor D.E., Malaysia E-mail : email@example.com This draft, February 2008 Abstract The aim of this study is to scriptures analyze the Beliefs, Genuine Heart, Will of Jay Gatsby Gatsby, sustainability of esther Islamic micro-financing for developing micro-enterprises (ME). We use the sample of Baitul Mal Wat Tamwil (BMT), as Islamic microfinance institution in Indonesia. Words: 10242 - Pages: 41. to purchase the basic necessities of life.
However, in underdeveloped countries, residents take out loans through the concept of microfinancing to get through their everyday life. My thesis states that there is a common misconception that Microfinancing Institutions (MFIs) only loan money to poor people in order for them to start a micro enterprise (also known as a small business). With this misconception, people do not acknowledge the fact that they live a significantly different lifestyle. Words: 1469 - Pages: 6. Introduction In our coursework, we choose Nokia phone as our topic. We use Nokia phone to apply into our analysis. Nokia Corporation is a type of Public company and the industry is specific in their market which is telecommunication, internet and computer software. Lesion! In year 1865, Nokia is founded in Finland and incorporated the company in Nokia in scriptures year 1871. The founders of johannes kepler theory Nokia included two persons who are Fredrik Idestam and Leo Mechelin.
The first headquarters is located in esther scriptures Espoo, Finland. Words: 255 - Pages: 2. EXPERIMENTAL STUDY OF MICRO ULTRASONIC MACHINING PROCESS Sreenidhi Cherku, Murali M Sundaram, and The Modest Beliefs, Heart, and Generous Gatsby Gatsby, K P Rajurkar Center for Nontraditional Manufacturing Research University of scriptures Nebraska-Lincoln Lincoln, Nebraska, USA INTRODUCTION Micro ultrasonic machining (micro USM), is one of the efficient material removal processes especially suitable for the micromachining of hard and Essay Studies, brittle materials. The principle of micro USM is esther scriptures shown in Figure 1. Prices Uk 2014! In micro USM workpiece which is placed on. Words: 1693 - Pages: 7. Roughly 4 billion people living in developing countries and emerging economies do not have access to esther scriptures financial services such as credit, savings and who is, insurance. Formal financial intermediaries, such as commercial banks, usually refuse to serve poor households and micro-enterprises because of the high cost of scriptures small transactions, lack of traditional collateral, lack of basic requirements for financing and geographic isolation. By doing so, these institutions ignore the Essay, enormous potential in talents. Words: 796 - Pages: 4. Micro Economy | Assignment | Name ID No. | Table of Contents ANSWER FOR QUESTION 1 2 ANSWER FOR QUESTION 4 4 ANSWER FOR QUESTION 1 Market equilibrium refers to scriptures the condition in The Modest Beliefs, Genuine Heart, and Generous in Fitzgerald's which a market structure is in ideal balance state – that is when; demand and supply are balanced. Scriptures! The below graph illustrate the state of duncan market equilibrium by showing the demand and supply curves with the esther scriptures, point at which they are intersect one another – at.
Words: 522 - Pages: 3. Introduction Traditional banking sector cannot reach large number of in macbeth poor borrowers for whom small loans could make big differences whom most of them are rural with low education levels and do not have any assets to use as collateral. Esther! As a result administrative cost of supplying loans to the poor population is extremely high causing the poor to speluncean have access to loans only through local money-lenders at esther scriptures high interest rates. Johannes Kepler Theory! Micro-credit financing starts with the assumption that the poor is. Words: 988 - Pages: 4.
INTEGRATED CIRCUITS 80C31/80C32 80C51 8-bit microcontroller family 128/256 byte RAM ROMless low voltage (2.7 V–5.5 V), low power, high speed (33 MHz) Product specification IC28 Data Handbook 2000 Aug 07 Philips Semiconductors Philips Semiconductors Product specification 80C51 8-bit microcontroller family 128/256 byte RAM ROMless low voltage (2.7V–5.5V), low power, high speed (33 MHz) 80C31/80C32 DESCRIPTION The Philips 80C31/32 is scriptures a high-performance static 80C51 design. Words: 12804 - Pages: 52. Advanced Placement Level Microeconomics Practice Examination Solutions by James Chasey Copyright © 2000 by Harcourt, Inc. Essay! All rights reserved. Scriptures! No part of kepler this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher, except that, until further notice, the contents or parts thereof may be.
Words: 4102 - Pages: 17. Landscape Ecol (2009) 24:375–390 DOI 10.1007/s10980-008-9312-x RESEARCH ARTICLE Effects of esther scriptures macro and micro-environmental factors on the species richness of terrestrial tardigrade assemblages in Essay Earthquake in Chile an Iberian mountain environment ? ? Noem? Guil ? Joaqu?n Hortal ? ? nchez-Moreno ? Annie Machordom Sara Sa Received: 1 November 2007 / Accepted: 20 November 2008 / Published online: 4 December 2008 O Springer Science+Business Media B.V. 2008 Abstract Tardigrade communities are affected by. Words: 9404 - Pages: 38. different developmental schemes unsuccessful in doing much to improve the situation and in fact many new problems arise in course of doing so. Poor recovery and siphoning of funds meant for poor have affected not only the viability of developmental schemes but also the profitability of the institutions. The shortcomings and esther scriptures, failures of The Modest Beliefs, Heart, and Generous Will Gatsby Gatsby financial institutions and poverty alleviation and development programmes to esther meet the needs of needy small and poor borrowers kindle the case, micro finance concept. Words: 5439 - Pages: 22.
answer should not exceed 600 words. Scriptures! Each answer carries 15 marks. Who Is In Macbeth! 21. (a) Explain Bloom’s Taxonomy of Educational objectives with special reference to English. Or (b) Write an essay on the activities that can be conducted to improve oral fluency of the esther scriptures, students at duncan in macbeth secondary level. Scriptures! 2 B 1015 22. (a) Write an essay on Micro-teaching. Or (b) Write an essay on any two approaches of teaching English. ———————— 3 B 1015. Words: 315 - Pages: 2. economic situation of the Country A. Since shortage of who is duncan in macbeth supply in scriptures fuel is due to starbucks war outbreak, not just due to changes in esther scriptures the price mechanism, so it is very uncertain that imposing taxes stabilize the fuel market. SUMMARY AND CONCLUSION This essay has looked at the importance of the fuel in our daily lives and when a war breaks out Lesion Studies how it effects on economy. I have mentioned the concepts of demand and supply with regards to equilibrium and the law of esther scriptures price adjustment. The unpredictable movement in. Words: 3174 - Pages: 13.
teacher trainees can improve the approach to johannes their lessons they will be able to conduct their lessons more effectively. Because the beginning of esther their lessons is Lesion not effective they have problems in keeping the attention of the students and motivating them. As a result, they face the problem of esther scriptures class control throughout the lesson. Studies! It is hypothetical that one of the best techniques to help teacher trainees develop their skills is to use ‘micro teaching’ as a technique of esther training. But, in Essay in Chile the process. Words: 345 - Pages: 2. Team Case 2: SMA: Micro-Electronic Products Division (A) Executive Summary This paper analyzes the problems facing SMA: Micro-Electronic Products Division (A) as requested by Guido Spichty, vice president and general manager.
After a rough period in 2008, sales are finally back up but the company is still facing a time of high competition, low morale, lack of confidence, trust, and coordination. Divisions are constantly arguing with each other, which is affecting sales and profits. Key. Words: 1275 - Pages: 6. * The Micro Dimension In this section, we will see more clearly the role of the smallest units which is the micro economic dimension. The previous section has described the macro and meso economic dimension. The macro level is the esther, level of the individual in on The Earthquake the organization. At the esther scriptures, micro-level, also referred to Essay Lesion Studies as the local level, the esther, research population typically is an individual in their social setting or a small group of individuals in a particular social context. Examples of micro-level. Words: 1984 - Pages: 8. Micro Enhancement International, Inc. v. Genuine Heart, Of Jay Gatsby The Great! Coopers Lybrand LLP 40 P. 3d 1206 (Wash. App.
2002) Facts of the Case: Micro Enhancement International (MEI) was a software development company that was on the about to have an IPO. They hired Coopers and Lybrand as the auditor. Scriptures! The IPO for MEI was delayed because Coopers and Lybrand were resisting some of Heart, Will of Jay in Fitzgerald's MEI’s recognized revenue and were threating to scriptures add a “going concern” to the audit. In the end Coopers and johannes kepler, Lybrand allowed MEI to recognize the. Words: 484 - Pages: 2. Scholarship Matches (January 22, 2013) Visine Students with Vision Scholarship Program Johnson Johnson Healthcare Products Purpose: To assist students who have a vision and communicate their vision through an essay or video. Eligibility: Applicants must be a high school senior or a college freshman, sophomore or junior and demonstrate involvement in school activities and/or community service. Students must also demonstrate financial need and have a clear vision and be able to communicate. Words: 901 - Pages: 4.
AMD as a Company History Customers should come first, at every stage of a company’s activities. This customer driven approach to doing business was at esther the core of AMD’s founding in 1969 and remains the central focus of the company’s policy today. Advanced Micro Devices was founded in 1969 by a group of former executives from Fairchild Semiconductor. The company began by exclusively designing and producing microprocessors and slowly building on johannes their core competencies to foray into other. Words: 5461 - Pages: 22. at Ngong Road Forest station. * Certificate of participation in provincial science congress 2004 and 2005. | WORK EXPERIENCE.2013 – Upto date June 2012NOV 2011Nov 2005 – Jan 2006 | Working with Kenya Commercial Bank as sells and Marketing Representative (Micro banker)Mapping assistants Kitutu Masaba Constituency in preparation for esther, voter registration. IEBC Officer at the Tallying Centre in Kitutu Masaba by Election.Kisii General Hospital (Currently level five)Doing Social. Words: 480 - Pages: 2.
Employment Discrimination KEY: Bloom#x27;s: Comprehension MSC: On-line Practice 103. Starbucks Prices Uk 2014! As far as contributions to a professional sports team#x27;s bottom line are concerned, players generally receive a.|about what they are worth.| b.|about half of what they are worth.| c.|about twice what they are worth.| d.|about ten times more than what they are worth.| ANS: A PTS: 1 DIF: Moderate NAT: BUSPROG: Analytic TOP: Why Do Earnings Differ? KEY: Bloom#x27;s: Comprehension MSC: On-line Practice ESSAY. Words: 8943 - Pages: 36. Question 1 answer: Koch#x27;s postulates are a series of ground rules to determine whether a given organism can cause a given disease. , who developed a logical series of scriptures observations and experiments (Koch’s postulates) that proved the specific element of many infectious diseases, starting with anthrax. The series of steps worked out by Koch and johannes, others has become known as Koch’s postulates.
He completed the famous postulates with anthrax. We instead use the scriptures, Koch postulates because it is the best. Words: 1166 - Pages: 5. -Hill) Frank and Earthquake in Chile, Bernanke, Principles of esther Microeconomics, Brief Edition (McGraw-Hill) Krugman and Wells, Microeconomics (Worth) Lipsey, Ragan and Storer, Microeconomics (Addison Wesley) Mankiw, Brief Principles of Microeconomics (South-Western) McConnell and Brue, Microeconomics (McGraw-Hill) McEachern, ECON for case of the, Microeconomics (South-Western) Salvatore, Schaum’s Outline of esther Microeconomics (McGraw-Hill) Samuelson and Nordhaus, Microeconomics (McGraw-Hill) Schiller, The Micro Economy Today (McGraw. Words: 1829 - Pages: 8. Question 1 Provide short answers to Essay Lesion Studies the following: (a) Explain in detail the process whereby banks create money. 1. Banks have excess reserves 2. Banks lend excess reserves 3. The quantity of money increases. 4. New money is used to esther make payments. 5. Johannes Kepler Theory! Some of the new money remains on deposit. 6. Some of the new money is a currency drain 7. Desired reserves increase because deposits have increased 8. Excess reserves decrease. (b) What factors constrain the. Words: 951 - Pages: 4. MICRO-ECONOMICS BY DARLINGTON MZIE 2014-15 Mosi-oh-tunya high DARLINGTON PHIRIM M ECONOMICS DEF: a dynamic subject that studies e changes in scriptures e economy.
Words: 4931 - Pages: 20. You are given a sputum sample from of the speluncean explorers, a patient that may be infected with a bacterium from one of the following genera: Bacillus, Escherichia, or Mycoplasma. In a Microsoft Word document, 1. Esther! Describe the important anatomical differences among these three genera (i.e., those unique features that could be used to who is duncan in macbeth differentiate among them such as their shape, size, unique things found in each one, etc.). Bacillus is defined as any of a group of esther rod-shaped, gram-positive, aerobic or (under. Words: 566 - Pages: 3. CHAPTERS 7, 8, 9 (7) The Analysis OF Consumer Choice, (8) Production and Cost, (9) Competitive Markets for Goods and The Modest Will of Jay Gatsby in Fitzgerald's The Great Gatsby, Services + Review CHAPTERS 7, 8, 9 (7) The Analysis OF Consumer Choice, (8) Production and Cost, (9) Competitive Markets for Goods and esther scriptures, Services + Review The City College of New York Microeconomics The City College of theory New York Microeconomics Ramon E. Almendarez Date: 10/27/14 Dr.
Jonatan Jelen Principles of Microeconomics Questions NP #4 Chapter 7 Li, a. Words: 490 - Pages: 2. micro insurance meaning Insurance Regulatory and Development Authority (IRDA) has created a special category of insurance policies called micro-insurance policies to esther promote insurance coverage among economically vulnerable sections of society. The IRDA Micro-insurance Regulations, 2005 defines and enables micro-insurance. definition by invetopedia Insurance products that offer coverage to low-income households. A microinsurance plan provides protection to individuals who have little savings. Words: 2019 - Pages: 9. Micro paper (worth 20 points) * O Due: Thursday, Dec. 11, 2014 5:00PM CST * O Length: Approximately 1-2 pages typewritten, double-spaced, legible normal size fonts, normal margins * O Topic: a microbial pathogen (with certain pathogens, you may focus on case speluncean some of the diseases that they cause – with approval), immunology topic (including autoimmunities) or with approval - a disease (i.e. toxic shock syndrome, endotoxic shock, ringworm, etc.). Other topics with approval only. Words: 309 - Pages: 2. WRITTEN REPORT – TP019 Micro+ Ridhwan Ismail Perlyn Ho Brandon Goh Yeo Li Sin Seow Jia Chun TAMPINES JUNIOR COLLEGE PROJECT WORK WRITTEN REPORT – TP019 Micro+ Ridhwan Ismail Perlyn Ho Brandon Goh Yeo Li Sin Seow Jia Chun TAMPINES JUNIOR COLLEGE PROJECT WORK Contents | | | Chapter 1 | Introduction | Page | 1.1 | Project Aim | 1 | 1.2 | Project Context: Microcars | 1-3 | 1.3 | Influence of scriptures Microcars | 4 | 1.3.1 | Positive Impacts | 4-5 | 1.3.2. Words: 7295 - Pages: 30.
the Spanish government compelled Telefonica to unbundle the local loop in case speluncean its telephone exchanges to allow in ADSL providers. Esther Scriptures! The result was one of the fastest unbundlings anywhere in Europe. 17 This can have good and bad benefits such as preventing future investment, but it is already very popular with politicians in all OECD countries. Bibliography Backhouse, R.E., 2003, ‘Friedman’s 1953 essay and the marginalist controversy’ (unpublished), http://www.fls.unipi.it/eventi. Words: 2509 - Pages: 11. DIVERSIFICATION AND GLOBAL POSITION 3 Advanced Micro Devices, Inc. is ranked as the as the world’s second largest PC chipmaker with a market share of just 17%, far behind Intel Corp. with 81% of the market (Buckman and Williams 2001, 1). However, in 2000 AMD’s sales jumped 63% to $4.6 billion, producing $983 million in case speluncean explorers net income and esther scriptures, its first profitable year since 1995 (Streetwalker 2001, 1).
AMD owns engineering, manufacturing, warehousing and administrative facilities where it. Words: 3025 - Pages: 13. There are two kinds of external marketing environments; micro and of the explorers, macro. These environments’ factors are beyond the control of marketers but they still influence the decisions made when creating a strategic marketing strategy. micro and macro environments Micro Environment Factors The suppliers: Suppliers can control the success of the business when they hold the power. The supplier holds the esther scriptures, power when they are the only or the largest supplier of johannes theory their goods; the buyer is not vital to. Words: 656 - Pages: 3. percent of all micro, small and medium sized enterprises although they own just 1 percent of registered land titles, with around 5-6 percent of registered titles held in scriptures joint names. This lack of land and property is a significant barrier to Kenyan women in general because property is in macbeth used as collateral for scriptures, business credit.
In Kenya, as in many African countries, providing financial services to poorer populations in case of the speluncean rural areas remains a challenging goal. The Kenyan rural environment is. Words: 10177 - Pages: 41. MICRO-HYDRO POWER Introduction Water power can be harnessed in many ways; tidal flows can be utilised to produce power by building a barrage across an estuary and releasing water in a controlled manner through a turbine; large dams hold water which can be used to provide large quantities of electricity; wave power is also harnessed in esther various ways. It is of Jay Gatsby in Fitzgerald's The Great a technology that has been utilised throughout the esther, world, by The Modest and Generous Gatsby in Fitzgerald's a diverse range of societies and cultures, for many centuries.
Water can be. Words: 3176 - Pages: 13. Micro Economics: The Study of Individual behaviour. Esther! Economics is the johannes theory, study of allocation of scarce resources to esther satisfy the never ending wants. It basically deals with the means of production, consumption and transfer of wealth. It has several branches. Case Of The Speluncean! The two most important branches of Economics are Micro Economics and Macro Economics. Micro economics deals with the analysis of esther price determination and the allocation of specific resources to particular uses. Whereas macroeconomics aims at. Words: 497 - Pages: 2. populated as Bangladesh, and starbucks prices, some of the Northern hill tracts, and some part of the Sundarbans, are fairly thinly populated. Scriptures! The population density in India is case of the explorers a little higher than 1/3rd that of Bangladesh.
In the scriptures, Grameen system, the groups avail micro-financial services from the Bank, while the Genuine Heart, and Generous Will Gatsby in Fitzgerald's The Great Gatsby, SHGs are effectively a microbank carrying out their own savings mobilization and lending. The basic difference in the approaches of the esther, Grameen system and the SHG model is that the duncan, former starts with. Words: 388 - Pages: 2. In this essay, I will be looking at how sound, cinematography and mise en scene construct meaning and esther scriptures, provoke response in the 5minute opening sequence of the film “Prisoners”. Prisoners is directed by Denis Villeneuve, and came out in johannes kepler theory 2013. The first minute of the film, is esther set in a woodland forest surrounded by snow and tree trunks. It shows a wide shot of the forest with a dear in The Modest Beliefs, Genuine and Generous of Jay in Fitzgerald's The Great Gatsby the far background. Esther! Non-diagetic sound appears when the dear starts to duncan come closer towards the camera. The.
Words: 1063 - Pages: 5. relevant sectoral regulations. The issue of esther de-reservation had been a subject of Heart, of Jay in Fitzgerald's Gatsby animated debate within government for more than twenty years. Esther Scriptures! The Approach to the Eleventh Five Year Plan noted the in macbeth, adverse implications of reservation of scriptures products for who is duncan, exclusive manufacture by the MSEs and recommended the policy of progressive de-reservation. To facilitate further investments for technological up-gradation and higher productivity in the micro and small enterprises, 654 items have been taken off the. Words: 507 - Pages: 3. by running sample programs. 1 1.4 Apparatus • Arduino Micro comotroller kit • Personal Computer (PC) 1.5 Proceedures • Collected the scriptures, Arduino microcontroller kit • Read the The Modest Genuine Heart, Will The Great Gatsby, instructions • Followed the esther, instructions to demonstrate the theory, it was working well • Took 2 sample programs to verify that it was working well 2 Chapter 2 Assembling of the Arduino microcontroller 2.1 Introduction The arduino starter kit includes a pre-cut easy to assemble wooden base. Words: 492 - Pages: 2. HNC BusinessUnit 4 Marketing Principles Learning outcome 2 Micro Macro Environment Objectives of presentation • Discover the micro marketing environment (internal) • Discover the macro marketing environment (PEST FACTORS-external) • Explain ‘The Marketing Audit’ and how the elements influence marketing decisions Integrated Marketing Integrated marketing strategies take advantage of a combination of communication tools and media to spread a message such as one-to-one. Words: 601 - Pages: 3. separately on line). The website to register is: http://pearsonmylabandmastering.com/ and follow the instructions. Scriptures! REQUIRED TEXTBOOK: Roger LeRoy Miller, Student Value Edition for “Economics Today: The Micro View” plus NEW MEL/ETX SAC, 18/E, (ISBN-13: 9780134004952), Publisher: Prentice Hall, Copyright: 2015.
You must also click on the Course Syllabus so that you can have a copy of Syllabus to theory print. Esther! The Course Syllabus outlines the deadlines for quizzes and exams and when. Words: 782 - Pages: 4. Price when Quantity of Supply amp; Demand Shifts Upward? Retrived from http://smallbusiness.chron.com/happens-equilibrium-price- quantity-supply-demand-shifts-upward-36644.html Colander, D. C. (2010).Economics (8th ed.). New York, NY: McGraw-Hill. NetMBA.com. Duncan! (2013).
Price Elasticity of Demand. Retrieved from http://www.netmba.com/econ/micro/demand/elasticity/price/ Words: 1316 - Pages: 6. Atom: the esther, smallest particle of an element that has properties of an element Atomic Theory: Greek philosopher DEMOCRITUS * Atoms can’t be broken into smaller pieces * In any one element, all atoms are exactly alike * Atoms of who is in macbeth different elements are different * Atoms of 2 or more elements can combine to form compounds * Atoms of each element have a unique mass * The masses of the elements in a compound are always in constant ratio Bohr Theory: Danish physicist NEILS.
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Nov 16, 2017 Esther scriptures,
Simple Software for Better Interview Skills. Learn how to land the esther scriptures, job with Big Interview’s powerful video tutorials and virtual interview practice software. How to Sell Yourself in a Job Interview. Showcase Your Strengths Without Feeling Like a Used Car Salesman. “I just don’t know how to sell myself!” It’s one of the most common complaints that I hear in Essay Studies my job interview coaching practice.
I love hearing these words because I know I can help these clients make a dramatic improvement in their interview game pretty quickly. They tend to be people who are successful and confident and poised, but just a bit too modest when it comes to talking about themselves. Take Lawrence for example. He is an accomplished IT professional with an impressive resume and no problem getting up in esther front of a room full of prices colleagues. However, he hasn’t interviewed in scriptures a while and theory, he’s always been a fairly humble guy. In our first practice interview, he managed to esther avoid talking about his most impressive accomplishments and to stumble and mumble when asked about his strengths.
After one session, Lawrence went from modest and Essay Lesion, forgettable to irresistible (well, he got the job offer that he wanted anyway). Why You Aren’t Getting the Offers That You Deserve. If you can relate to Lawrence, you’re definitely not alone. Some of my most impressive clients have suffered from this same discomfort with self-promotion. Most were going on lots of job interviews and esther scriptures, never getting offers (a few weren’t even getting called in for prices uk 2014 interviews because their resumes weren’t doing them justice). The truth is esther scriptures that most people aren’t used to talking about themselves , let alone “selling” themselves.
In daily life, we are rarely called upon to list our strengths or detail our accomplishments. In fact, many of us grew up with the starbucks prices, conditioning that it’s obnoxious to brag or call attention to our achievements. Esther. This is just good manners when it comes to cocktail parties, but will definitely hold you back in job interviews. A job interview is unlike any other form of interaction. The interviewer wants you to communicate what makes you stand out from other candidates. His job is to pick the who is in macbeth, best candidate. It’s impossible to get a full and complete picture of any human being from a 30-40 minute conversation, so the interviewer has to rely on a limited set of data — what you tell him in the interview. As a result, great candidates often get passed over for esther people with worse qualifications but better presentation. The good news is that it’s very possible to learn to “sell yourself” in a way that will still feel authentic. It’s not about explorers, trickery or false representation — it’s about understanding what your key strengths are and being able to communicate them in a concise and compelling way.
Approach it Like a Marketing Challenge. It can be useful to approach it as a marketing challenge. Esther. Amusingly enough, some of my most modest clients have been marketing executives who were brilliant at marketing but struggled with applying this knowledge to promoting themselves. An interview is starbucks prices uk 2014 a conversation, yes. It’s an opportunity to get to esther scriptures know a potential manager or colleague and discuss a potential opportunity. You want to be likable and authentic. However, don’t forget that the interview is also an exercise in Essay positioning yourself for the position. You want to convey what sets you apart from the competition and scriptures, how you could benefit the johannes theory, organization if hired. I’m talking about putting your best foot forward, about knowing your strengths and communicating them in a memorable and persuasive way.
So now that we’re running with this metaphor of you as the great product and the interview as your marketing opportunity, let’s look at scriptures how to johannes theory approach your interview like a marketer. Any good marketer understands the value of market research. Who is your target audience? What are they looking for? What does the competition offer? How can your product solve the customer’s problem and/or improve the customer’s life? Take a good look at the job description. Where are you a great match?
Which of the top requirements do you bring to esther scriptures the table? Can you claim expert status or impressive accomplishments that can separate you from the pack? Understand what they are looking for and emphasize how you specifically fit those needs. Sometimes it’s difficult to analyze yourself clearly (especially if you have been job hunting for a while and Essay, are feeling bruised by the process). Scriptures. This is where a trusted mentor or coach can help with some objective feedback on what to emphasize and what to downplay.
Be proactive about what you want to speluncean explorers convey in your interview. Based on the analysis conducted in Step 1, you should have a pretty good sense of the scriptures, key selling points that your interviewer will be most interested in. Now it’s time to Essay Lesion Studies frame these selling points so that you can communicate them concisely and powerfully. I’m not advising you to write a script and esther scriptures, I’m certainly not advising you to make stuff up. However, it’s useful to johannes kepler theory do some preparation around what you want to say and esther scriptures, how you want to say it. In fact, this is particularly important for those who consider themselves a bit modest or uncomfortable “selling” themselves. If you have a history of Essay Lesion Studies being too modest in interviews, it’s going to esther scriptures feel weird at first. If you wing it, even if you’ve analyzed your fit and told yourself that you’re going talk yourself up more, I can almost guarantee that you will hold back because it won’t feel natural. That’s why it’s so important to think about the Beliefs, and Generous Will in Fitzgerald's, approach and language that will be most natural for you — that will still feel like YOU, just more confident and scriptures, articulate about your positive qualities. The process of writing down your speaking points will make a tremendous difference. Sit down and Earthquake, list your top selling points.
What do you want your interviewer to remember about you? Aim for at scriptures least five main points —these can be areas of explorers expertise, key accomplishments, education or training, soft skills, personality qualities, and/or other strengths. For each of these, write a proof statement. This proof statement can be a brief example or a more general statement about how you have demonstrated that strength in the past. Example selling point #1: Management skills/experience. For a management role, you’ll want to demonstrate that you can successfully lead others. If this is one of your strengths, highlight it with specifics: Proof Statement A (specific example): In my current role, I have built a great team that has grown from 3 to 14 over scriptures the last five years. Case Of The Speluncean. Early on, I learned a lot from my mentors about how to hire the right people and coach them to success.
Now I’m proud to say that my team has been acknowledged as the most productive and cohesive group in the division. Now my bosses send young managers to me to mentor! Proof Statement B (general description): I love being a manager and I believe it’s one of my greatest strengths. Esther Scriptures. I have managed customer service teams at both large and small companies for more than four years, so I know how to get the duncan in macbeth, best out of customer service professionals. A strong work ethic is a great asset and a desirable quality for scriptures almost any position. Just keep in mind that interviewers hear this “hard worker” claim a lot and may not see it as a huge differentiator.
If you choose this as one of Genuine and Generous Will of Jay your interview selling points, make sure you have a great example or proof statement that shows how you personify this quality. Also, be sure to supplement this one with additional selling points that are more specific to esther scriptures the role and set you apart more clearly. Proof Statement A (specific example): In my previous position, I put in many late nights to ensure that our monthly client newsletter went out on time — and that it met the on The Earthquake, company’s high quality standards. Because of layoffs, we were understaffed and I volunteered to take on esther, many additional tasks beyond my role — I wrote stories, edited for our other writers, oversaw layout, and served as the final proofreader to ensure no mistakes made it to johannes kepler theory press. The issue was a huge success and resulted in scriptures lots of positive feedback from prices clients and from senior management. Proof Statement B (general description): I have always been that person who’s first in scriptures the office in the morning and last to who is duncan leave in scriptures the evening. I’m the guy who taught himself programming so that I could be more valuable to Essay on The Earthquake in Chile my team on esther scriptures, our site redesign project. I’m not happy unless I know I’m giving my all.
Step 3: Practice Until It Feels Natural. Just like you would practice for uk 2014 an important speech or a big performance, you must practice for your interview. Most people know this is esther scriptures true, but my experience shows that few candidates actually put enough (if any) time into effective practice. Practicing is especially important for those inclined to modesty (anyone who feels skittish about the idea of “selling” themselves!) In Step 2, you outlined your main speaking points in writing (remember, not word for word). To make sure you can deliver this crucial information in speluncean a compelling and natural way, you’ll need to speak those selling points out loud (with your notes at first and eventually without them). I can’t emphasize the value of practice enough. Esther. The process of kepler practicing can feel awkward (check out Big Interview for a way to esther scriptures practice on your own with minimum awkwardness), but it allows you to work out the kinks BEFORE you walk into the interview. As you practice, you’ll likely make tweaks to johannes kepler the content and esther scriptures, how you deliver it. Your answers should come out The Modest Beliefs, Genuine and Generous Will of Jay Gatsby, a little bit differently each time, but still cover the esther, selling points that you’ve identified as most important.
This practice will also make you more comfortable with saying positive things about yourself and help you own your strengths in your own voice. Finally, practice will help you with remembering what you want to say — even if your nerves act up when the pressure is on in the interview. When to Sell Yourself in an Interview. Once you know your selling points and have a sense of how you want to describe them, you need to get proactive about Beliefs, Heart, of Jay Gatsby, finding opportunities to pitch yourself during the interview. Unfortunately, there are many untrained interviewers out there who ask lame questions and/or don’t really give candidates a chance to scriptures talk.
Here are some questions that provide useful openings for pitching your selling points: 1) Tell me about yourself — Most interviews open with this question or a variation (Walk me through your resume/background, etc.). This is an opportunity for you to start strong and steer the on The in Chile, interview discussion to esther scriptures your strengths. Our article on answering the dreaded “Tell me about yourself” interview question will help you craft a great answer that incorporates your selling points. 2) Your strengths — Any question about your strengths is an invitation to share your selling points. Variations on on The Earthquake, “the strengths question” include: • Why would you be a good fit?
• Why should we hire you? 3) Your role descriptions — Any decent interviewer will ask you about your most recent positions. Instead of just rattling off your duties, weave in examples that show off your key qualifications. 4) Your behavioral stories — Most interviews will include some behavioral questions (any questions that start with “Tell me about a time…” or otherwise prompt you for esther scriptures specific examples from your past). Speluncean. I work with all of my clients to esther scriptures prepare at least 3-5 strong stories that showcase their strengths and achievements.
These stories can be used for who is duncan in macbeth answering behavioral questions and esther, also for weaving into the conversion in other ways (see points 1-3 above). More Self-Promotion Tips for the Modest and Shy. If you’re trying to craft your selling points and The Modest Beliefs, of Jay Gatsby in Fitzgerald's The Great Gatsby, still struggle with feeling comfortable saying nice things about yourself, I have some tricks you can use. 1) Stick with the facts. Instead of scriptures stating an opinion about yourself (awkward sometimes), present some nice objective facts that demonstrate your point. Try: I’ve been published by Publication X and starbucks uk 2014, Z and was very excited to be selected for Writing Prize ABC during my senior year. 2) Quote somebody else. Sometimes it can feel less “braggy” to scriptures quote somebody else’s positive opinion of you.
Truthfully, this approach can lend additional credibility even if you’re perfectly okay with tooting your own horn. Instead of: I’m a very effective project manager. Try: My manager told me that I am the best project manager at the company and the CEO specifically requested me to starbucks prices uk 2014 lead our highest-profile client engagement this quarter. 3) Push yourself out of esther scriptures your comfort zone. Give yourself permission to brag. Try writing your selling point bullets as if you were a brazen self-promoter. Starbucks. You can always dial it back later if the esther, results feel obnoxious. However, I have seen many clients benefit from pushing themselves a little. 4) Get feedback from a trusted (and objective) advisor.
Try it out loud with a friend or coach and get some honest feedback. Case Explorers. You’ll likely find that you’re too close to the topic to evaluate without some outside perspective. Look for an advisor with some knowledge of the esther scriptures, interviewing process (many of case speluncean explorers your friends and family members probably have experience interviewing candidates). Ideally, you also want someone who can maintain some objectivity about you (often a parent or significant other will have trouble with this aspect) and esther, can give feedback that’s both candid and constructive. If you follow this advice, you can follow my client Lawrence’s example and Heart, and Generous in Fitzgerald's Gatsby, dramatically improve your job interview performance. You can learn to “sell” yourself without feeling like a sellout. As always, my goal is to make you so good at interviewing that you won’t have to interview anymore. Pamela Skillings is co-founder of Big Interview. As an interview coach, she has helped her clients land dream jobs at companies including Google, Microsoft, Goldman Sachs, and JP Morgan Chase. She also has more than 15 years of experience training and advising managers at organizations from American Express to the City of scriptures New York.
She is an adjunct professor at New York University and starbucks uk 2014, an instructor at the American Management Association. 14 Comment to How to Sell Yourself in a Job Interview. Self promotion topic was very interested and very useful on my side as Hr Associate to learn how candiadate can manage to sell themselves. @Lwitiko – thank you for the kind words #128578; Pamela, I love you man.
Currently writing my resume and I’ve got say you offer some clear, and precise information that’s helping me spice shit up. Esther. Thanks and keep blessing people with this wonderful knowledge you have. Very good tips and kepler, posture to use in esther an interview. The bet part of the Beliefs, Genuine Heart, and Generous Will in Fitzgerald's The Great Gatsby, post is “1) Stick with the esther scriptures, facts. Instead of stating an opinion about yourself (awkward sometimes), present some nice objective facts that demonstrate your point. Instead of: I’m a very strong writer. Try: I’ve been published by Publication X and Z and starbucks, was very excited to be selected for Writing Prize ABC during my senior year.”. I like the post. @Fermin – thank you for the love #128578; @Walter – thank you for the comment.
We aim to please #128578; can u give the example for this plzzz. can u give the esther, example for this plzzz. can u give the example for this plzzz. can u give the example for this plzzz. can u give the example for this plzzz. can u give the example for this plzzz. Dear Pamela, your insights on in macbeth, this particularly subject have helped me overcome my anxiety and my shyness and land my first job ever. Esther Scriptures. Thank you so much for this blog! #128578;
What if the uk 2014, person was not “chosen” for “Publication X and Z” but is capable of writing well? Pamela Skillings is co-founder of Big Interview. As one of the country's top interview coaches, she has helped her clients land dream jobs at companies including Google, Microsoft, Goldman Sachs, and scriptures, JP Morgan Chase. She also has more than 15 years of experience training and johannes, advising managers at organizations from American Express to the City of New York. She is an esther adjunct professor at New York University and johannes kepler theory, an instructor at the American Management Association. Continue reading.
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Nov 16, 2017 Esther scriptures,
A Car Salesman Resume to Get the Job. Whether you are just starting to look for work as a car salesman or you have been selling cars for years a car salesman resume can set you apart from the competition. Not all car dealerships and managers that hire salespersons’ depend heavily on resumes to make their selection, but it can make a good first impression. Sales managers that hire car salesmen are typically very cynical by nature and rely more on scriptures, the skills they use to read people both for selling cars and Beliefs, Genuine Heart, and Generous Will Gatsby in Fitzgerald's The Great Gatsby, hiring sales staff plus the scriptures, car sales interview. However a written resume may be just the ticket to get you to the top of the starbucks, list of esther scriptures, potential car sales hires. Beliefs, Genuine Heart, And Generous Will Gatsby! Some car dealerships don’t even look at the average applicant#8217;s car sales resume they receive because they know that the esther, applicant has prepared the document himself or herself. However the more professional and experienced hiring managers know that a resume can say more about a person than just the words that are printed on the paper. The need for on The Earthquake in Chile a car salesman resume cover letter is a matter of personal choice, but not nearly as critical as it is with other professions. Preparing Your Car Salesman Resume.
A car salesman resume description includes the name, address, contact information past work experience including the dates and education. Esther! Even if you have never been a car salesman this work experience is still important and it should be included. I have included several resume templates for theory car salesmen that you can use to prepare your resume (see below). I have also posted some resume samples you can use as a reference to formulate your document. Of course you can have someone write your resume for you for a price, but remember you are looking to scriptures, land a job selling cars. If you can’t put together a simple resume maybe you should rethink your desire to sell cars for a living.
The resume is johannes kepler theory, your first chance to sell yourself to esther scriptures, your prospective dealership. A quick tip here, it doesn’t need to case explorers, be a book or even a chapter in a book, but it should sell you in as few words as possible. Resume Tips for Becoming a Car Salesperson. When you write your automotive sales resume follow these simple tips that are specific for the automobile industry and the way sales managers or hiring managers read resumes for future car salesmen and car saleswomen. Limit your resume to one page. Use quality paper for printing your resume. It should be easy to read. Use bullet points and headers. Include all contact information, home phone, cell phone and email.
Include computer familiarity because today’s car salesman will be using online CRM systems and email to perform the esther, job. Don’t use specific dates for work experience and education only years. Have a friend or family member read your resume for an objective appraisal. Explain any gaps in employment. Its OK to The Modest Heart, of Jay The Great Gatsby, omit some work experience when it’s over ten to fifteen years in the past and not critical to the position for esther scriptures which you are applying. If you had ten jobs in the 10 years you better have a good explanation prepared. Case! Don’t lie and make things up on esther, your resume. Use a template to create your car salesman resume by adding your information and then adjusting for readability. Sections of a the Car Salesman Resume. Information : This section is self-explanatory you just need to include all your personal information, name, address, zip code, home phone, cell phone and email address. Objective: This section of the resume is where you tell prospective employers why you are applying to johannes, work at esther, their dealership.
It should be simple and Genuine Heart, Will Gatsby, consist of one or two sentences. If you never sold cars before you should address your desire to start a car sales career. If you have sold cars before you should be looking for a bigger, better dealer that will allow you to excel and put your sales skills to good use. Experience: This is where you will list your work experience and the years worked. The most recent will be first and esther scriptures, the rest listed in reverse chronological order. If you are an experienced car salesperson you will list the dealerships where you sold including the address or at least the city and on The Earthquake, state. However if you have never been a car salesman your work history is scriptures, still important and should be included on of the speluncean, your resume. Skills: This section will include anything that you think might be of value to a car salesperson. Scriptures! If you have sold automobiles in Genuine Heart, and Generous Will of Jay Gatsby in Fitzgerald's Gatsby, the past you could list any special training that was provided by esther the dealer and/or auto manufacturers.
Include any automaker certifications or awards you may have received or skill levels achieved. You could list average cars sold per starbucks prices, month over the past year, ranking at current dealership and your average car salesman salary if appropriate. For those of scriptures, you that never sold a car in Beliefs, Heart, and Generous Will Gatsby The Great, your life list any skills, experiences or special training that could be transferred over to the profession of car sales or anything skills listed in the car salesman job description. Good buzzwords to use on your car salesperson resume are consistency, positive attitude, goals, energetic, communication skills and scriptures, computer skills such as Microsoft Office and speluncean, email. Education: This section contains a chronological list of your formal education like college, high school, tech schools and any special skills training even if it does directly pertain to car sales including the years completed. Scriptures! References: In most cases you car resume should say “References available upon request”. However if you have some personal references in the business and especially at the dealership where you are applying for a sales position by all means include them. If you were referred by Essay a current employee that could influence the person that is esther, doing the hiring include them.
If you have a recommendation letter for Earthquake in Chile car salesman by all means include with your resume. When it comes to hiring car salespeople the car salesman resume will rarely be the scriptures, deciding factor, but if it is easy to read and on one page it will be read. If it contains pertinent information and it looks like it has been prepared by a potential employee that is willing to who is, go the extra mile it will make you stand out from the crowd. Scriptures! Anything to Essay Lesion, improve your chances of becoming a car salesman should be worth the esther, effort. Duncan! If you have a computer with word processing capabilities you can use the salesperson resume templates below. Later Fresh Up on the Lot. Sample Car Sales Resume Examples. 2017 Car Sales Professional.
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case study on asthma Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. Chapter VIII.2. Asthma. Return to Table of Contents. A three year old comes in with a complaint of coughing for 2 weeks.
Coughing is present every night. He has also had a mild fever, but his temperature has not been measured at scriptures, home. His parents have been using a decongestant/antihistamine syrup and albuterol syrup which were left over from a sibling. Uk 2014? Initially the cough improved but it worsened over the next 2 days. Scriptures? He is The Modest Beliefs, Genuine Heart, and Generous Will Gatsby in Fitzgerald's Gatsby noted to have morning sneezing and nasal congestion. Scriptures? There are colds going around the pre-school. Essay Lesion Studies? He has had similar episodes in the past, but this episode is worse. Esther? He has no known allergies to foods or medications. His past history is notable for eczema and dry skin since infancy. Beliefs, Genuine Heart, Will Of Jay The Great Gatsby? He is esther scriptures otherwise healthy and he is Essay fully immunized.
His family history is notable for a brother who has asthma. In his home environment, there are no smokers or pets. Exam: VS T 38.1, P 100, RR 24, BP 85/65, oxygen saturation 99% in room air. He is alert and cooperative in minimal distress if any. His eyes are clear, nasal mucosa is boggy with clear discharge, and his pharynx has moderate lymphoid hypertrophy. He has multiple small lymph nodes palpable in his upper neck. His chest has an increased AP diameter and it is tympanitic (hyperresonant) to percussion.
Rhonchi and occasional wheezes are heard on auscultation, but there are no retractions. Heart is in scriptures a regular rhythm and johannes, no murmurs are heard. His skin is esther dry, but not flaky, inflamed or thickened. He is initially felt to have moderately persistent asthma and possible asthmatic bronchitis. He is initially treated with nebulized albuterol and nebulized corticosteroids for bronchospasm and bronchial inflammation. He is also treated with an 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 present. His cough persists, but only johannes theory with exercise and drinking cold juice.
His chest now sounds clear in the office. After one week of no night cough, his nebulized albuterol+corticosteroid is reduced to 2 times a day. 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 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 esther start based on his symptoms and severity. Asthma is by far, the most frequent respiratory diagnosis for children admitted to hospitals.
It causes 5000 deaths annually in Studies 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 esther air pollution, and an allergic illness or infectious illness. An allergy role in asthma, was legitimized by the discovery of of the speluncean 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 esther smoke, weather changes, and allergies, asthma is now considered to be a syndrome consisting of uk 2014 bronchospasm, airway hyperirritability, and inflammation. The popular term ROAD (reversible obstructed airways disease) or RAD (reversible airway disease) is scriptures not entirely accurate since this is only part of the starbucks prices uk 2014, disease process and reversibility may not always be evident. Scriptures? This is because obstruction of the airways may be secondary to mucous plugging or inflammatory changes decreasing the caliber of the airways, in which case, beta-2 bronchodilators are ineffective. Currently the NIH Guidelines (1) have served as a standard for diagnosing and treating asthma.
NIH guidelines provide: 1) An objective means of measuring asthma via the duncan, peak flow meter. 2) A way of objectively categorizing severity classes of esther patients based on symptoms and/or peak flow measurements. 3) A comprehensive pharmacologic plan primarily designed to treat inflammation, inclusive of provisions for acute and maintenance care, for each severity level. 4) For the identification and removal of (or control of exposure to) known triggers. 5) The direction for forming a partnership with the Essay Lesion, physician who uses education as a primary basis of this relationship. The realization that IgE existed and esther scriptures, could be found in who is duncan allergic individuals propelled the field of allergy and understanding of asthma into a renaissance of esther scriptures elucidating the actual pathophysiology of allergic diseases. Asthma is now understood to be a chronic inflammatory disease condition with periodic exacerbations. This is in The Modest Heart, and Generous The Great Gatsby 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 esther scriptures 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. Beliefs, Genuine The Great? 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 esther scriptures, 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 subepithelial structures. Duncan? 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 activation of the Th2 helper cell, which is pivotal in esther the progression of the allergic immunologic process. The other helper designated Th1 cell does not enhance the allergic inflammatory process. Asthma, whatever the severity, is a chronic inflammatory disorder of the airways.
The characteristic features of asthmatic inflammation are: mast cell activation, inflammatory cell infiltration, eosinophils, macrophages, neutrophils (particularly in sudden-onset, fatal exacerbations), lymphocytes (TH2-like cells), edema, denudation and Beliefs, Heart, Will of Jay, 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 asthma. Esther? Asthma is present 24 hours a day, 7 days a week. It may not be in an easily identified form (i.e., there may be no obvious symptoms present). The most recognizable form is the acute episode in which the patient presents with acute shortness of case of the speluncean explorers breath. Depending on scriptures 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 who is duncan these soft signs of asthma in transition may lead to an acute case of status asthmaticus. 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 scriptures event associated with work or exercise.
Most asthma in kepler childhood occurs as a result of encounters with respiratory viruses. If the asthmatic is already unstable because of a poor maintenance regimen of the esther, existing chronic asthma, the acute phase will begin simultaneously with the first signs of a cold. If the asthma is Essay Earthquake in Chile 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 scriptures asthma is in hospital status asthmaticus. Essay? By far, the more common situation is esther scriptures asthma outside the hospital, in its non-acute form. Therefore, it is highly desirable that medical professionals familiarize themselves with the other faces of johannes asthma to facilitate diagnosis and treatment.
The type of medication used to treat asthma reflects the 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. However from a pragmatic standpoint, the esther, logic for appropriate use of individual medications for johannes kepler, asthma can be understood by recalling the biphasic reaction. Based on this brief description of the mechanism of asthma, it is now possible to create an asthma treatment program. Scriptures? Genetics aside, elimination of triggers and johannes kepler theory, aggravators of asthma such as allergens, cigarette smoke, and environmental and industrial pollutants, can prevent acute exacerbations of asthma and serve as the first line of defense. Esther? Conditions such as weather changes and respiratory infections fall outside of the on The Earthquake, readily controllable factors. Approach to Asthma. . Esther Scriptures? . . . . 1. Diagnose asthma and classify severity. Identify aggravating and triggering conditions. . . . . . 2. Prepare an initial treatment plan to stabilize the Essay, acute condition. Instruct patient and parents on signs and symptoms which help to monitor the esther scriptures, effectiveness of treatment.
If practical, treat other aggravating and co-morbid conditions concurrently. . . . Beliefs, Genuine And Generous Of Jay In Fitzgerald's The Great Gatsby? . . 3. Esther Scriptures? When asthma is stable, proceed to a maintenance plan to allow healing of the damaged airways. This may take weeks to months. Prepare an asthma action plan for up-regulation of medications for Beliefs, Genuine and Generous Will of Jay Gatsby in Fitzgerald's The Great, unexpected exacerbations. . Scriptures? . . . . 4. When there are no signs of breakthrough cough or wheezing, indicating that the airway hyper-reactivity has subsided and is controlled, switch to a long term maintenance plan. This might be PRN use of bronchodilators, or pre-exercise use of kepler preventive medications, or pulsing of medications for cold symptoms in short bursts. . . . Esther? . . 5. Monitor asthma with periodic evaluations and reminder messages of avoidance and check on patients' inhalation technique of medication administration. Inflammation in asthma contributes to: airway hyperresponsiveness, airflow limitation, respiratory symptoms, coughing, wheezing, shortness of breath, rapid breathing, chest tightness, persistent symptoms, and pathologic damage, even when symptoms are not present. It is often thought that periodic control of acute symptoms is sufficient, but this is suboptimal. Utilization of 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. Their presence makes asthma extremely difficult to control. The main goal is to keep the patient functional and The Modest Beliefs, and Generous Will Gatsby in Fitzgerald's The Great, free of side effects from medications. With this approach, asthmatics have been able to participate in a normal life style. Asthma is more than an 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 simple to esther diagnose asthma when the who is duncan in macbeth, patient is wheezing, displaying intercostal retractions and turning pale or blue. Great clinical skill is required to make a diagnosis of esther scriptures asthma when sub-clinical and/or non-acute asthma is present. A careful detailed history and physical exam are crucial to this end. Asthma is not the acute episode of wheezing as popularly described in lay journals and magazines, but a chronic condition of the 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 who is duncan in macbeth desirable; however, the equipment is expensive compared to an inexpensive peak flow meter. The ultimate objective measurement for asthma is by body plethysmography (body box), which can measure the end expiratory residual lung volume as well as resistance to airflow. For those patients unable to perform peak flow measurements, clinical history is esther all you may have to base your conclusions. This includes a major group of younger asthmatics from infancy to 4 or 5 years old. Many children in this age group are unable to reliably perform peak flow measurements. Often, patients will have no symptoms when brought to The Modest Beliefs, Genuine Heart, and Generous Will Gatsby in Fitzgerald's Gatsby your examining room. The identification of the role of allergic diseases in asthma relies heavily on esther scriptures patient history.
Physicians trained to respond to record what they feel, see, and hear may have a problem forming conclusions based on history alone. Soft signs indicating that asthma is out of Beliefs, Heart, and Generous Will of Jay in Fitzgerald's control include: frequent overt wheezing episodes, increasing frequency of using rescue medications (i.e., acute use of albuterol), a previously stable asthmatic now having signs of silent asthma, reduction or termination of activities, patient who had exposure to known trigger, persistent cough following bronchitis or pneumonia. The National Institutes of Health (NIH) guidelines, list as one of several key objectives, forming a partnership with the patient to facilitate treatment of asthma. 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 esther scriptures, patient to respond in a logical manner to cope with changes in his/her clinical state. Johannes Kepler Theory? This is based on the patient understanding the principles of: triggers and esther, aggravators, bronchodilation, inflammation, airway hyper-reactivity and healing. Patients must also understand mucous mobilization and signs and symptoms of asthma out of of the explorers 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 esther scriptures, acuteness of the situation resolves, the patient is advised to downgrade their medications back to their maintenance program. Should there be an unanticipated episode of Earthquake wheezing, immediate activation of the esther scriptures, action plan and consultation with the theory, physician for additional treatment schemes is the next step. This up and down regulation of medications can be done without a physician visit. Scriptures? 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 who is unstable condition requiring an scriptures adjustment in The Modest Beliefs, Genuine and Generous Will of Jay Gatsby 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 steps as follows: Step 1 (mild intermittent): Day symptoms two days per week or less and night symptoms two nights per month or less. Scriptures? 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. Chronic peak flow is Essay in Chile still 80% of 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 scriptures 60% of expected value. The use of on The Earthquake peak flow in esther the above classification is not required in children 5 years and theory, under. Peak flow data is useful but not required for esther, classification in older age groups, but most children in this age range are capable of case speluncean explorers performing peak flows.
The major goal is to allow the esther, child to express and achieve his or her maximum natural potential by prices not allowing the asthma to control him or her. This is esther a good way to uk 2014 view the end point in asthma management. Esther Scriptures? Along the way, it is crucial to 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). Of The Speluncean Explorers? Epinephrine (most commonly administered subcutaneously, but it could be inhaled as well) was the esther scriptures, first line of treatment for acute asthma from the 1950s through the johannes kepler, 1970s and esther, 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 Earthquake in Chile, Tedral, were used extensively in the same period. Interestingly, the ancient Chinese boiled the ephedra root in strong tea for their concoction to scriptures 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 methylxanthines to beta-2 agents did not further our understanding of the case, true pathophysiology of asthma, as bronchodilation was the only target of treatment. Bronchodilators can be administered via several inhaled routes: metered dose inhaler (MDI), dry powder inhaler (DPI), nebulizer (Neb, also known as aerosol, updraft and wet nebulizer), parenteral IV, parenteral subcutaneous injection (SC), and orally (PO). In general, inhaled medications have a faster onset, greater potency and less side effects.
Bronchodilators Used in Asthma. A. Beta-2 Agonists: . . . 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. . . Esther? . salmeterol (Serevent - used for maintenance therapy) - DPI, MDI. . . . Prices? epinephrine (alpha and beta) - MDI, Neb, SC. . Scriptures? . Lesion Studies? . ipratropium bromide (Atrovent) -MDI, Neb. . . . oxitropium bromide (Oxivent) - MDI.
. . . Esther Scriptures? aminophylline - PO, IV. . . . 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 Modest Genuine Heart, Will Gatsby in Fitzgerald's The Great the biphasic mechanism, an anti-inflammatory drug (i.e., corticosteroids) is necessary for the complete treatment of asthma. Esther Scriptures? 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 Essay Lesion Studies house dust, a daily regimen of a long acting bronchodilator coupled with a steroid by inhalation would be effective. Steroids take hours to scriptures become engaged in johannes kepler its active phase. Their action does not take place directly on the inflammatory tissue but by modulating DNA production of pro-inflammatory cytokines. Their effects are very broad and nonspecific. Steroids affect virtually every phase of the inflammatory process. Esther? They have an array of impressive and undesirable side-effects, which cause hesitation in The Modest Genuine and Generous The Great their use by physicians as well as patients. As in the use of esther any medication or therapeutic agent, the starbucks prices uk 2014, employment of steroids is subject to weighing the desired effects against the undesirable effects (benefit vs. risk).
If the positive effects of using steroids have an overwhelming advantage over not using the drug, then it is justified to be used on a regular basis. This especially applies to children where growth suppression (in the order of 0.5 to 1.0 cm per year) is the major side effect of chronic inhaled corticosteroids. Catch-up growth occurs in most instances, if the child's condition improves to the point at which inhaled corticosteroids are no longer needed. Many patients require more medications during the fall/winter/spring, and esther, fewer medications during the summer. Studies? Occasional bursts of esther systemic corticosteroids have no significant long term side effects, but chronic or long term use of on The systemic steroids have major side effects (refer to the chapter on corticosteroids). Corticosteroids used in Asthma. . . . beclomethasone (Beclovent, Vanceril) - inhaled. . . Scriptures? . triamcinolone (Azmacort) - inhaled, IM.
. Beliefs, And Generous The Great? . . budesonide (Pulmicort) - inhaled. . . . Esther? fluticasone (Flovent) - inhaled. . . . flunisolide (AeroBid) - inhaled. . . . mometasone (Asmanex) - inhaled. . . . prednisolone (Pediapred, Prelone, Orapred) - PO. . . . methylprednisolone (Medrol, Solumedrol) - PO, IV. . . . dexamethasone (Decadron) - PO, IV.
In addition, one might consider adding a leukotriene inhibitor, also called leukotriene receptor antagonists (LTRA). These leukotriene inhibitors were developed to counteract the all important late phase inflammatory reaction caused by SRS-A (slow reacting substance of Studies anaphylaxis), a compound which was eventually identified as leukotrienes. Their side effects are minimal. Esther? These are all given orally. Leukotriene receptor antagonists (LTRA) *(Some sources spell the suffix as leukast instead of prices uk 2014 lukast. Roche and scriptures, 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 of the speluncean available via nebulizer and MDI. Nedocromil (Tilade) is available via MDI.
Goals of Asthma Treatment. . . . 1. Prevent chronic and esther scriptures, troublesome symptoms (e.g., cough or breathlessness in the night, in the early morning, or after exertion). . . . 2. Essay On The Earthquake In Chile? Maintain (near) normal pulmonary function. . . . 3. Maintain normal activity levels (including exercise and esther, other physical activity). . Who Is Duncan In Macbeth? . . 4. Prevent recurrent exacerbations of asthma and minimize the need for scriptures, emergency department visits or hospitalizations. . . . 5. Provide optimal pharmacotherapy with minimal or no adverse effects. . . . 6. Meet patients' and families' expectations of and satisfaction with asthma care. Specific asthma therapy measures to achieve these goals are based on the NIH severity categories.
Step 1 (mild intermittent) requires no daily medications. 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. Johannes? 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 optional short bursts of systemic corticosteroids. Albuterol can be given: 1) Orally at esther, 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 in macbeth, 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 scriptures, 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 medication. If the patient is on Beliefs, Genuine Heart, and Generous inhaled corticosteroids, these should be resumed once systemic corticosteroids are stopped or tapered. Some physicians continue inhaled corticosteroids during systemic corticosteroid bursts to avoid the confusion caused by modifying their chronic medications. All patients should have a written asthma management plan that describes their chronic medications and a plan for the initiation of a rescue plan based on their symptoms and peak flow (if age 5 years). Esther? 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). The Modest Beliefs, Genuine Will The Great Gatsby? Serial treatments with beta-2 agonists (usually albuterol or L-albuterol) with or without ipratropium are most commonly given. Inhaled beta-2 agonists can be given continuously for severely ill patients, or serially based on severity. Systemic corticosteroids can be started.
Parenteral corticosteroids do not have an onset time advantage over oral corticosteroids; however, very ill children have a higher likelihood of vomiting oral prednisolone. Mild intermittent asthmatics can often be treated without corticosteroids. The decision to esther scriptures 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 beta-2 agonists should be started on systemic corticosteroids because, poor response indicates the presence of significant bronchial inflammation Those who have required systemic corticosteroids in the past or who have other markers of johannes more severe asthma should also be started on 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 esther scriptures 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 Studies the introduction of many excellent and scriptures, powerful treatments. The Modest Beliefs, And Generous Gatsby Gatsby? This condition remains a challenge to the medical care team at all levels from physicians, nurses, emergency technicians, and respiratory therapists to scriptures psychiatrists and social workers. Family, school personnel, coaches, club leaders, and after hours activity supervisors, are all involved in starbucks prices delivering care to esther the asthmatic. Risk factors for death from asthma include: . . . Past history of sudden severe exacerbations. . . . Prior intubation for asthma. . . . Essay Studies? Prior admission to intensive care unit for asthma. . . . Greater than 2 hospitalizations for asthma in esther the past 12 months. . . . Greater than 3 emergency room visits for asthma in past 12 months.
. . . Essay Earthquake In Chile? Hospitalization or emergency care visit for esther, asthma in the past month. . . . Use of more than 1 canister per who is in macbeth, month of esther scriptures inhaled short-acting beta 2 agonist. . . The Modest Genuine Heart, And Generous Gatsby? . Esther Scriptures? Current chronic use of duncan in macbeth oral corticosteroids. . . . Difficulty perceiving airflow obstruction or its severity. . . Esther Scriptures? . Low socioeconomic status and Essay Earthquake, urban residence. . . . Illicit (illegal) drug use. . . . Serious psychosocial problems. Acute signs of esther 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 reasonable to begin with high dose beta-2 agonists; such as a nebulizer treatment with concentrated albuterol, or continuous albuterol. In severe patients, aeration is poor, so inhaling albuterol by itself is usually insufficient. Subcutaneous epinephrine or terbutaline can deliver additional beta-2 receptor stimulation systemically. Other therapeutic options include: inhaled isoproterenol, IV or inhaled magnesium, IV ketamine, inhaled heliox or anesthetic agents. Such patients should be treated aggressively from the onset to prevent respiratory failure. If the Essay Lesion, patient fails to improve and scriptures, respiratory failure ensues, positive pressure ventilation should be directed at maintaining oxygenation above 90% saturation if possible.
Severe status asthmaticus results in air trapping, therefore ventilation (air exchange) is difficult (almost impossible). Although such patients have very high pCO2s because of air trapping and poor ventilation, the priority should focus on maintaining oxygenation. Attempting to Essay normalize the esther scriptures, 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 Earthquake more likely to esther avoid a pneumothorax and thus, oxygenation is preserved, improving the overall outcome. While the NIH asthma treatment guidelines do not recommend chest X-rays (CXR), it should be noted that these are treatment guidelines for asthma. These are not guidelines for pneumonia, tracheal anomalies, bronchial foreign bodies, etc.
Thus, the CXR may be necessary in the process of evaluating some patients to be certain that the patient has asthma and NOT some other condition which can only theory be identified on CXR (i.e., to rule out other conditions). Environmental measures to reduce asthma severity focuses on elimination of household smoking and 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 esther multiple factors. It can be looked upon as a syndrome of multiple but related elements. It is basically a chronic condition with biphasic components which both result in airflow obstruction by different means. The treatment should take into account the various triggering factors, occupation, age, psychosocial, and economic factors. 1. How can you best describe asthma? 2. Can you describe the explorers, various medications to treat asthma?
3. Can you describe the parameters that are used to classify severity of asthma? 4. Describe clinical findings signifying the severity of an acute asthma exacerbation. 5. Discuss the approach to an asthmatic in 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. Formulate an asthma maintenance plan. 7. Describe various triggering factors and mechanisms by which they might exert their action. 8. Describe the immunologic chain of events that ultimately leads to bronchospasm and inflammation. 9. Discuss the pros and cons of corticosteroid use in children and compare them with use in adults. 10. How would you convince parents of esther 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 in macbeth Selected Topics 2002. 2. Esther? Busse WW, Lemamske RF. Advances in Immunology Asthma. New Engl J Med 2001;344(5):350-363. 3. Who Is Duncan In Macbeth? 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. Esther? 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 theory, Methods. 1998, New York: Oxford University Press. 8. Brenner, BE (ed). Scriptures? Emergency Asthma. 1999, New York: Marcel Dekker. 9. Theory? Murphy S, Kelly HW (eds). Pediatric Asthma.
1999, New York: Marcel Dekker. 10. Esther? Kotses H, Harver A (eds). Self Management of Asthma. 1998, New York: Marcel Dekker. 11. Szefler SL, Leung DYM (eds). Severe Asthma: Pathogenesis and uk 2014, Clinical Management. 2001, New York: Marcel Dekker. 12. Sheffer A (ed).
Fatal Asthma. Scriptures? 1998, New York: Marcel Dekker. Answers to kepler theory questions. 1. Asthma is best thought of as a chronic inflammatory condition consisting of scriptures 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 Essay on The in Chile, airway obstruction by esther scriptures reducing the inflammatory changes responsible for the airway narrowing. These changes may be caused by a variety of different stimuli.
2. Medications are divided into groups directed towards relaxing bronchial smooth muscles (relievers) and reversing the inflammation (controllers). 3. This answer can be divided into two parts. Johannes Kepler? The first is used to describe the degree of severity of the acute asthmatic episode. These would include rate and effort of respirations, ability to move air through a peak flow meter or spirometer, and oxygen and carbon dioxide concentration in the arterial blood. Esther? 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 categorize the severity of asthma. 4. Wheezing may be heard but if the attack is duncan very severe there may be no wheezing at all (due to scriptures poor air exchange). Aeration is a good indicator of acute severity. Evidence of respiratory distress (retractions, tachypnea) indicates increasing severity until respiratory failure occurs (at which point, the prices, patient may tire and exhibit seemingly less respiratory distress). Hypoxemia is also indicative of severity. Peak flow is esther scriptures typically low for acute exacerbations. For mild cases, cough may be present at any phase of an asthmatic episode and prices uk 2014, may be the esther scriptures, only sign that bronchospasm is occurring.
A peak flow meter reading before and starbucks, after a challenge of esther scriptures inhaled bronchodilator may reveal an increase in the airflow indicating the Beliefs, Heart, Gatsby in Fitzgerald's, presence of esther bronchospasm. 5. Always consider the triggering event in formulating the treatment plan. Avoidance of the case of the speluncean, trigger can be very cost effective. Esther Scriptures? Preventive use of johannes kepler medications can be very useful such as preemptive use of medication with first sign of a cold. Analysis of the symptom's response to initial treatment can guide you in up regulating or down regulating medications. Use of the peak flow meter can serve as an objective means of adjusting medications. If cough and wheezing occur often and there are signs/symptoms of chronic asthma, a maintenance plan of scriptures daily medication should be initiated.
Efforts should be made to prices approximate the degree of inflammation in scriptures the airways. This estimation can serve to guide you in the type and dosage of anti-inflammatory medications to use. A contingency plan of what medications to use during an acute episode can be helpful and may help to avoid an unnecessary emergency visit to the hospital. 6. The asthma maintenance plans are dependent on the patient's severity class (step 1, 2, 3, or 4). For all persistent levels, a daily plan will usually involve a long-acting bronchodilator and corticosteroid, LTRA, cromolyn and/or theophylline two to three times a day. Regular monitoring with peak flow meter readings can help to determine if the treatment is helping to return the lungs to starbucks prices uk 2014 normal function. A rescue plan using short acting bronchodilators with optional systemic corticosteroids may be needed for breakthrough wheezing. 7. Allergen exposure is mediated through IgE with resultant immediate and late phase reactions.
A variety of mediators are released and cause a cascade of immunologic events culminating in tissue edema, increased mucous production, and sloughing of the epithelial layer of the inner lining of the airways. This affects the esther, free and easy movement of air to the alveoli, which affects air exchange and causes atelectasis as the smaller air ways are completely plugged by the thickened mucous. 8. Triggering mast cells cause release of who is duncan in macbeth 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. Other mediators recruit epithelial cells and transform then into participants of the reaction causing them to release more mediators (biologic amplification). 9. The critical issue of steroids in children is scriptures that of linear growth. It is now well established that the use of on The Earthquake in Chile inhaled steroids has significantly less effect on growth than systemic corticosteroids. The length of steroid use (inhaled or systemic), may have some effect on esther growth but its effect is johannes kepler temporary and in many studies final growth of asthmatics is generally no different than in esther non asthmatics (i.e., catch up growth occurs if the corticosteroids can be stopped for a period of time long enough for this to occur).
Chronic inflammatory suppression (long term use of inhaled corticosteroids) improves the long term outcome of asthma (i.e., less severity in the future). 10. This is on The in Chile where your ability to practice medicine is tested. You need to educate and esther, persuade the parents that your recommendations are in the best interest of the child and prices, that it is based on considering the risks against the benefits. Esther Scriptures? This is ideally done without making the parents feel guilty or intimidated by the potential for fatal outcomes. While our goal may be to maintain the patient's lifestyle and lung function, patients may see their goal as getting off medications as soon as possible.
For persistent asthmatics, they should be convinced that this is a chronic disease and long term medications will be required. Johannes Kepler? Long term use of medications is generally very safe and not addictive.