Thursday, March 5, 2020
Assisted Ventilation in Status Asthmaticus Essays
Assisted Ventilation in Status Asthmaticus Essays Assisted Ventilation in Status Asthmaticus Paper Assisted Ventilation in Status Asthmaticus Paper Assisted Ventilation in Status Asthmaticus Background When a patient is admitted in the Intensive Care Unit (ICU) with a diagnosis of status asthmaticus, it means that the asthma attack is extremely severe and critical. In this situation, the patient does not respond to high doses of steroids and inhaled bronchodilators. According to Groth, this resistance to medication is most likely the consequence of three things that make it extremely hard to get air in and lout of the lungs. These three factors are as follows:  ·Ã‚        Bronchospasm, which is a condition of an extreme spasm of the airways.  ·Ã‚        Edema, which is a condition when the lining of the airways is swelling.  ·Ã‚        Thick mucus secretions in the airways. Normally, when an individual breathe in, the airways are pulled open when the chest wall becomes larger; however, when the individual breathe out, the airways have a tendency to collapse, locking in air in the chest. However, when a person is an asthmatic, emptying the lungs takes a long time for the reason that the airways are restricted. An asthmatic person cannot totally empty the lungs prior to having to take one more breath. When a person is severely asthmatic, he/she experiences shorter breathing so he/she tries to breathe faster and he/she has little time to exhale. When this happens, the lungs keep hold of, or â€Å"trap,†lots of air, which is called hyperinflation or air-trapping. Moreover, this procedure makes it more difficult to take another breath in, and the breathing muscles have to try harder and make more effort to take in any air. Groth said that a young or if not a healthy asthmatic can more often than not surmount this complexity, but at the expense of a c onsiderable strain on the breathing muscles. Then, when this demand is continued for too long, for instance due to resistance to medicine, the asthmatic person’s breathing muscles can get exhausted and he/she will acquire respiratory failure. Furthermore, according to Corbridge and Hall (1995), status asthmaticus is a life threatening type of asthma described as a situation in which an increasingly worsening attack is impassive or not responsive to the customary proper treatment with adrenergic drugs and that causes pulmonary insufficiency. The most important mechanical occurrence in status asthmaticus is a progressive rise in airflow resistance. In addition, mucosal edema or inflammation and mucous plugging are the primary causes for the late recovery in status asthmaticus. Ibsen added that the combination of acidosis, hypercapia, and hypoxia together with the mechanical consequences of increased lung volumes might bring about or cardiovascular arrest or cardiovascular depression. Indications for ICU Admission            Schwarz and Lubinsky (1997) asserts that a person with status asthmaticus should be admitted to ICU when he/she feels the following:  ·Ã‚        Exhaustion  ·Ã‚        Altered sensorium  ·Ã‚        Presence of high-risk factors  ·Ã‚        Use of continuous inhaled beta-agonist therapy  ·Ã‚        Failure to improve in spite of adequate therapy  ·Ã‚        Increasing PCO2 ins spite of treatment  ·Ã‚        Markedly decreased air entry Due to difficulty in breathing, a person with status asthmaticus admitted in then ICU is ventilated through assisted or mechanical ventilation. Groth said that a mechanical ventilator takes over the function of breathing in the course of status asthmaticus; however, it does nothing to overturn airway inflammation or bronchospasm. The main function of a mechanical ventilator is to sustain breathing for the exhausted muscles until such a time when a variety of medications become helpful and effective. For a patient in the ICU to obtain mechanical ventilation, he/she needs an endotracheal tube, which is a plastic tube that is inserted by means of the nose or mouth into the windpipe or trachea and is linked to the ventilator. Moreover, the patient must likewise be sedated with an opioid-like morphine called fentanyl and medically paralyzed so as to let the ventilator function effectively and to make the patient comfortable. Mechanical Ventilation            If the patient has already undergone rapid extubation but still suffers difficulty of breathing, there is probably a failure in extubation. Werner (2001) says that extubation is a major complication of translaryngeal intubation, but its impact on mortality, duration of mechanical ventilation (MV), length of intensive care unit (ICU) and hospital stay, and need for ongoing hospital care has not been adequately defined.            Hence, in the case of extubation failure, the patient in the ICU should be intubated. Epstein et al., (2000) said that as many as 20% of extubated patients require reintubation (specifically extubation failure) within 72 hours of extubation, with the exact prevalence depending on numerous factors. The pathophysiologic basis of extubation failure is often different from the cause of weaning failure. Extubation failure substantially prolongs the duration of mechanical ventilation, intensive care unit stay, and hospital stay, and substantially increases hospital mortality. Therefore, prediction of extubation outcome and prevention of extubation failure may be critically important. Unfortunately, standard weaning tests have not proven sufficiently accurate in predicting extubation outcome. New semi-objective measurements of cough strength and secretion volume can help recognize patients at increased danger for extubation failure. It is signifi cant to observe that mortality increases with reintubation delay, which illustrates that clinical worsening might occur during the period without ventilatory support. As a result, better result possibly will come from rapid detection of patients at increased danger, followed by quick reinstitution of ventilatory support when extubation failure happens. Schwarz and Lubinsky (1997) also said that the patient in the ICU should be intubated and mechanically ventilated he/she suffers the following:  ·Ã‚        Diminishing level of consciousness  ·Ã‚        Significant hypoxemia that is poorly responsive or unresponsive to supplemental oxygen therapy alone  ·Ã‚        Apnea or respiratory arrest  ·Ã‚        Impending respiratory failure marked by significantly rising PCO2 with fatigue, decreased air movement, and altered level of consciousness The choice to intubate an asthmatic should be done with tremendous concern. According to Cox, Barker and Bohn (1991), positive pressure ventilation in an asthmatic person is made difficult by acute air trapping and airway obstruction that causes hyperinflated lungs, which might refuse to accept further inflation and puts the patient at high danger of barotrauma. As a result, mechanical ventilation must be carried out just in the face of constant deterioration regardless of maximal bronchodilatory therapy. Moreover, Werner (2001) agrees that the assessment and choice to intubate an asthmatic should not be taken without due consideration, and intubation must be prevented if possible. Tracheal intubation may aggravate bronchospasm (O’Rourke Crone, 1982) and positive pressure ventilation will significantly boost the danger of circulatory depression and barotraumas (Williams et al., 1992). According to Corbridge and Hall (1995), ventilator management can be challenging to a certain extent. For this reason, the following principles should be applied in taking care of a patient with status asthmaticus in the ICU:            1.Do not attempt to regulate or normalize the pCO2. Tolerate hypercapnia, and make use of pharmacologic buffering agents if needed to raise the pH to 7.2. How high a pCO2 you could do with to endure is determined by the pressures required to ventilate the patient.            2.Make an effort to keep plateau (alveolar) pressures 30-35 cm H20. Peak pressures might be higher than this because of increased airways resistance.            3.Small tidal volumes are typically required because of propensity and high resistance for air trapping. 5-7 cc/kg is a logical and practical place to begin.            4.Rate must be low and expiratory time long, inspiratory time somewhat short. The plan is to leave as much time as possible for expiration, without causing the inspiratory pressure to be extremely high since you are attempting to get the gas in over too short a period. Rates of 10-14 and I:E ratios of 1:4 to 1:6 are usual.            5. Pressure cycled or volume cycled ventilation can be employed. If employing volume-cycled ventilation, be certain to look at the pressures generated cautiously. If employing pressure cycled, the ventilator will typically not arrive at â€Å"plateau†or no flow, and you have to look at the volumes delivered. Regular reassessment is vital.            6.If you come across problem with oxygenation or just cannot move the chest, manually bag the patient and re-examine therapy and ventilator strategy.            7.Case series and some anecdotes show that there has been certain success with the use of pressure support ventilation in the sedated, but not paralysed, intubated asthmatic. Its regular use has not been subjected to controlled trials.            8.The patient should be well sedated and generally paralyzed during mechanical ventilation. Constant infusions or doses scheduled on a regular basis must be used.            9.Premedicate with lidocaine and extra sedation prior to suctioning to lessen the bronchoconstriction in reaction to stimulation.            10.Go on with insistent bronchodilator therapy-aerosols or MDIs, atrovent, intravenous terbutaline, and steroids. Take into account â€Å"kitchen sink†therapies like ketamine, magnesium, isoflurane, and helium. Respiratory Acidosis, Metabolic Acidosis and Permissive Hypercapnea as a Lung Protective Strategy According to (Rebuck and Read, 1971), the customary regulation that respiratory acidosis determines or affects intubation has become outdated. With the start of more insistent utilization of inhaled b-agonist therapy, 1% of asthmatic children confined in the hospital (Cox, Barker and Bohn, 1991) and around 5 to 10% of asthmatic patients confined in pediatric intensive care (Pirie et al., 1998) need intubation. Rebuck and Read (1971) maintains that asthma is a sickness of airway obstruction, specifically, increased airway resistance, causing persistence of the time constant or the time required for lung units to fill and empty. Hence, slow ventilator rates are typically required. Tuxen and Lane (1987) also claims that during high peak airway pressures, the rule of mechanical ventilation of patients with status asthmaticus is controlled hypoventilation, putting up with higher levels of PCO2 so as to peak inspiratory pressures and reduce tidal volume. The incidence of respiratory acidosis goes after that of hypercarbia (Nowak, 1983). In addition to acute airflow limitation, metabolic acidosis might also happen (McFadden and Lyons, 1968). Numerous instruments are possibly included. Then, according to Roncoroni et al. (1976), if cardiac output is compromised, hypoxia of the peripheral tissues might trigger lactic acidosis to build up or worsen. Furthermore, increased oxygen consumption by the respiratory muscles might be a factor as well. Also, it might likewise be generated with the aggressive administration of nonselective sympathomimetics (Appel et al, 1983). Darioli and Perret (1984) established the idea of controlled hypoventilation with lower-than-traditional respiratory rates and tidal volumes in asthmatic adult patients, and discovered a significantly reduced frequency of barotrauma and death measured up to to historical control subjects. Meanwhile, this idea has been broadly accepted and realized to develop outcomes in asthmatic adult patients. Moreover, this concept, which is called permissive hypercapnia has also been reported in asthmatic children patients. Dworkin and Kattan (1989) dispensed mechanical ventilation to 10 children with the purpose of keeping peak inspiratory pressure , 60 cm H2O and arterial pH . 7.10; Paco2 ranged from 40 to 90 mm Hg; then, they did not detect air leak following intubation, and all of the 10 children survived. In addition, Cox et al (1991) said that when asthmatic children being given mechanical ventilation with initial tidal volumes of 10 to 12 mL/kg at rates of 8 to 12 breaths/min, inspirat ory time was set at 1 to 1.5 s (considering an expiratory time of approximately 5 s), and tidal volumes were modified to keep peak inspiratory pressures at 45 cm H2O, just two postintubation pneumothoraces were observed, and all children survived without sequelae in spite of considerable hypercarbia throughout mechanical ventilation. Werner (2001) said that permissive hypercapnia could be endured provided that the patient continues to be sufficiently oxygenated. A longer I:E ratio, frequently more than 1:3-4, helps tolerate slow but total emptying of the lungs during exhalation, helping and assisting ventilation and preventing unnecessary further air-trapping (auto-PEEP). The utilization of positive end-expiratory pressure (PEEP) is contentious (Werner, 2001). A person with status asthmaticus in respiratory failure on mechanical ventilation frequently has a considerable amount of air trapping that causes intrinsic PEEP, which possibly will be worsened by means of continuing PEEP during exhalation. Nevertheless, a number of patients may perhaps gain by the addition of PEEP, maybe by way of preserving airway patency during exhalation. Therefore, in a patient in the ICU who continues to be refractory to the initial ventilatory settings with no or very low PEEP, carefully escalating the PEEP may possibly demonstrate to be beneficial. Werner (2001) added that customarily, slow controlled ventilation with heavy sedation and with or without muscle relaxation is the strategy employed to ventilate patients with status asthmaticus. However, warning is necessitated, because the use of muscle relaxants with high-dose steroids has been linked with the growth of prolonged paralysis. On the other hand, a number of practitioners give an account of ventilating children with status asthmaticus with pressure support alone, enabling the patient to set his or her own respiratory rate as identified by his or her own physiologic time stable at the same time helping ventilation by means of relieving the fatigue caused by considerable work of breathing. Noninvasive positive pressure ventilation (NPPV), for instance, continuous positive airway pressure (CPAP) or bimodal positive airway pressure (BiPAP) delivered by way of a facemask, has been utilized for support of status asthmaticus. NPPV has been demonstrated to splint the airways, letting better exhalation and emptying (Werner 2001). Tuxen and Lane (1987) asserted that patients necessitate monitoring and supportive measures during mechanical ventilation. They also said that patients might be uneasy and air hungry while ventilated with low respiratory rates, and hypercapnia as a result of an approach of controlled hypoventilation. Preferably, flow-volume loops should be monitored to determine if sufficient time is given for exhalation to evade breath stacking, which happens if the next breath is delivered prior to exhalation is finished. Moreover, monitoring auto–positive end-expiratory pressure (auto-PEEP) and exhaled tidal volume is vital as well. Pirie et al. (1998) said that electrolytes and fluids must be monitored. Prior to arrival in the hospital, children with status asthmaticus have frequently had reduced oral intake and might have been vomiting as a consequence of respiratory difficulty or adversative effects from their medications. This causes decreased intravascular volume status that might be potentiated by the outcomes of positive pressure ventilation. Furthermore, cardiac output might be reduced as a consequence of lessened preload that are caused by auto-PEEP and air trapping. This decreased cardiac output and intravascular volume might perhaps be complemented by metabolic acidosis. Intravascular fluid expansion is necessary to cure hypotension, hypoperfusion, or metabolic acidosis. Moreover, diastolic hypotension might irregularly develop from high doses of beta-agonists. A vasoconstrictor (specifically, phenylephrine or norepinephrine,) might be taken into account if considerable diastolic hypotension in the face of sufficient intravascular volume persists. Monitor serum electrolyte levels, as medications used to treat asthma can result in significant kaliuresis (Tuxen and Lane, 1987). Meanwhile, Nowak et al. (19833) said that placement of indwelling arterial catheters offers nonstop blood pressure monitoring in addition to arterial blood gas sampling. They also maintained that blood gases must be monitored to evaluate response or reaction to therapy in mechanically ventilated patients.            Meanwhile, mechanical ventilation utilizing unsuitable settings can generate acute inflammatory response in the lund and acute parenchymal lung injury. The related release of cytokines into alveoli and the systemic circulation (Ranieri et al., 1999) might be a factor to multiple organ dysfunction (Slutsky and Tremblay, 1998) and mortality in acute respiratory distress syndrome (ARDS). â€Å"Lung-protective†ventilation strategies try to evade these outcomes by means of restraining peak lung distension and evading end-expiratory collapse, tolerating the hypercapnia that frequently results; such strategies decreased mortality rate in ARDS in two randomized trials (Slutsky and Tremblay, 1998). Hypercapnia is normally considered as an adverse result of limiting alveolar stress, but in a series of studies, Laffey, Engelberts and Kavanagh (2000) have asked whether hypercapnic acidosis per se might be a factor to the advantages of lung-protective ventilation. They demonstrated that in isolated perfused rabbit lungs, respiratory acidosis protected the lung from ischemia–reperfusion injury, while respiratory alkalosis potentiated the damage. The protective result of respiratory acidosis was linked with inhibition of xanthine oxidase, and was prohibited by means of buffering the acidosis; specifically, the protection was because of the acidosis instead of hypercapnia.            Acidosis restrains the cytokine expression and respiratory burst in macrophages (Roncoroni et al., 1976). Then, Laffey, Engelberts and Kavanagh (2000) have talked about other studies recommending cytoprotection by hypercapnic acidosis. Hence, even though it appears that it is impossible that all of the evident advantage of lung protective ventilation is a direct result of hypercapnia, the hypothesis tackled by Laffey, Engelberts and Kavanagh (2000) is a significant and sensible one. If â€Å"lung-protective ventilation†in ARDS does decrease pulmonary and systemic inflammation, and possibly multiple organ dysfunction, hypercapnic acidosis as such could possibly be somewhat responsible, maybe by downregulating inflammatory cells, and perhaps other mechanisms in addition to inhibition of xanthine oxidase. Therapy and Care in the ICU ICU therapy begins in step-wise fashion and escalates to a â€Å"kitchen sink†approach. This is because there is fairly little data which points to one combination of therapies being superior to others, and because an asthmatic deteriorating despite â€Å"usual†therapy is in significant danger. Standard therapy includes steroids (solumedrol) and beta-agonists (intermittent aerosols, continuous aerosols, or intravenous terbutaline). â€Å"Adjunctive†therapy includes anticholinergic agents (Atrovent). Chest physiotherapy and/or IPV (intermittent percussive ventilation) may be helpful and/or necessary for some patients.â€Å"Kitchen sink†therapies include magnesium, helium, ketamine, antibiotics, inhalational anesthetics, aerosolized lasix.            Based on the literature of Groth, the patient in the ICU must be prescribed continuous nebulization of albuterol for the first eighteen hours after the patient’s admission to the Intensive Care Unit and then switch to intermittent albuterol every two hours. Inhaled ipratropium could also be added every 6 hours. Ipratropium is an anticholinergic bronchodilator, and reduces bronchoconstriction through a different means. Then the patient will continue to be treated with a high dose of intravenous corticosteroids. He/she will also be given antibiotics if he/she has a fever, a high white blood cell count, and increased cough and mucus indicating that he/she has an infection.            Groth also asserted that several of the treatments of last resort employed in status asthmaticus consist of giving general anesthesia with inhalational anesthetics, which are very effective and powerful bronchodilators. Nevertheless, the help of an anesthesiologist will be needed to give this kind of treatment. Intravenous anesthetics like ketamin, can be useful as well. Recommendations Sin Fai Lam, Mow and Chew (1992) said that a more open-minded use of the ICU for patients with severe asthma has formerly been promoted. Procrastination might bring about a respiratory arrest. The result is at all times worse following a respiratory arrest; Lee, Tan and Lim (1997) gave an account of a merely 50% survival from hypoxic brain damage following a respiratory arrest despite good intensive care treatment. It is not advantageous to wait until the patient is almost dilapidated from CO narcosis to take control of the airway. If active airway intervention is unavoidable, it is preferable to come up with this decision early instead of late. This means that it is better to be pro-active instead of procrastinating. Early endotracheal intubation and mechanical ventilation in the patient with life threatening asthma might be practical procedures that can save life and bring about good clinical outcome. Complete signs for intubation are cardiac and respiratory arrest or considerable alteration in mental state. At other instances, the decision made in the face of increasing exhaustion and progressive deterioration. Based on the various literature discussed in this paper, would like to see more patients who need ventilation be intubated electively instead of as a consequence of a cardiorespiratory arrest. Blood gas abnormalities by itself are not a sign to intubate the patient. Several patients with respiratory acidosis and hypercapnia will respond and react to treatment with bronchodilators and do not need mechanical ventilation. More significant is the development in clinical findings and in the arterial blood gases. Furthermore, procrastination in the instigation of mechanical ventilation when it is certainly necessary is connected to the fear of complications. Definitely, contemplation and reflection should at all times be provided to the possible dangers. Intubation in a dyspnoeic, relentless and anxious patient must be carried out by the most knowledgeable and skilled clinician available. A large endotracheal tube must be chosen because it helps suction and lessens airways resistance. Based on the literature, there are advantages of both oral and nasotracheal intubation, and sedative options in the preparation of the patient differ among people. When endotracheal intubation has been performed, the physician’s priority should be to take control with positive pressure ventilation. This will necessitate the utilization of sufficient sedation and typically paralysis with a muscle relaxant. Paralysis might regularly merely be necessary in the first stages of ventilation, and must be weaned off as soon as possible to lessen the danger of acute myopathy. Ventilation must primarily be in the CMV manner. Ventilatory settings should also be selected to evade extreme lung inflation. This approach will lessen the danger of systemic hypotension or pneumothorax. Lung inflation is lessened by means of permitting a sufficient time for exhalation (TE). Meanwhile, expiratory time may perhaps be prolonged by means of reducing minute ventilation (VE) by either minimizing inspiratory time (TI) or lowering respiratory rate RR or tidal volume (VT). Inspiratory time is lessened through increasing inspiratory flow rate and by means of employing a square flow wave form. Tidal volumes of 8-10 mls/kg with a respiratory rate of 10-14 and inspiratory flow rates of 60 L/min or higher are frequently appropriate (Sin Fai Lam, Mow and Chew, 1992). A suitable peak airway pressure of 50 mm H20 should be aimed for. Furthermore, controlled hypoventilation is a method employed to lessen the danger of hypotension and barotrauma. The goal is to guarantee sufficient oxygenation, stay away from extreme dynamic hyperinflation (DHI) and tolerate a degree of hypoventilation. It is completely tolerable to let the PCO 2to increase so as to evade DHI. One must not try to normalize the PCO2 to the detriment of DHI (Lee, Tan and Lim, 1997). Hypotension might be attributed to too much DHI. A short experiment of apnoea (30-45 seconds) is indicative, as blood pressure rises and venous return increases during the period of apnoea. If this does not occur, other causes of hypotension like fluid depletion, tension pneumothorax, unnecessary sedation or myocardial depression should be taken into account. Lastly, A number of studies have evidently revealed that mechanical ventilation saves lives in life-threatening asthma (Sin Fai Lam, Mow and Chew, 1992). With good ICU management, the period of required ventilation is short, complications can be kept to a minimum, and there is more often than not no problem in weaning the patient off the ventilator. Nevertheless, we should remember that ultimately, the therapy and remedy of acute life-threatening asthma does not merely begin 3 days prior to the attack, but much earlier, as most acute attacks are avoidable with the appropriate use of standard and regular prophylactic medication, the proper education of patients, the avoidance of trigger factors, the appropriate implementation of a co-management plan between the patient and his doctor, the objective measurement of the PEFR, and the accessibility to medical care in times of crisis.# References Appel D, et al. (1983). Lactic acidosis in severe asthma. American Journal of Medicine. Corbridge T, and J. Hall. (1995). The assessment and management of adults with status asthmaticus. American Journal of Respiratory Critical Care Med. Cox R, G. Barker, and D. Bohn. (1991). Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus. Pediatric Pulmonology. Darioli R, and C. Perret. (1984). Mechanical controlled hypoventilation in status asthmaticus. American Review of Respiratory Disorder. Epstein, S. et al. (2000). Effect of Unplanned Extubation on Outcome of Mechanical Ventilation. American Journal of Respiratory Critical Care Med. Groth, M. Status Asthmaticus. Retrieved from http://denverpost.healthology.com Laffey J, D. Engelberts, and B. Kavanagh. (2000). Buffering hypercapnic acidosis worsens acute lung injury. American Journal of Respiratory Critical Care Med. Lee K, W. Tan, and T. Lim. (1997). Severe asthma. SMJ. McFadden E. Jr, and H. Lyons. (1968). Arterial-blood gas tension in asthma. N Engl J Med. Nowak R, et al. (1983). Arterial blood gases and pulmonary function testing in acute bronchial asthma: predicting patient outcomes. JAMA. O’Rourke P. and R. Crone. (1982). Halothane in status asthmaticus. Critical Care Med. Pirie J, et al. (1998). Changes in treatment and outcomes of children receiving care in the ICUs for severe acute asthma. Pediatric Emergency Care. Rebuck A, and J. Read. (1971). Assessment and management of severe asthma. American Journal Medicine. Roncoroni A, et al. (1976). Metabolic acidosis in status asthmaticus. Respiration (Herrlisheim). Ranieri V, et al. (1999). Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome. JAMA. Schwarz A, and P. Lubinsky. (1997). Acute severe asthma. In: Levin DL and Morriss FC, eds. Essentials of Pediatric Intensive Care. 2nd ed. Vol 1. Sin Fai Lam K, B. Mow, and L. Chew. (1992). The profile of ICU admissions for acute severe asthma in a general hospital. SMJ. Slutsky A, and L. Tremblay. (1998). Multiple system organ failure. Is mechanical ventilation a contributing factor? American Journal of Respiratory Critical Care Med. Tuxen D, and S. Lane. (1987). The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe airflow obstruction. American Review of Respiratory Disorder. Werner, H. (2001). Status Asthmaticus in Children : A Review. CHEST. Williams T. et al. (1992). Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. American Review of Respiratory Disorder.
Tuesday, February 18, 2020
Curriculum review circle Research Paper Example | Topics and Well Written Essays - 1250 words
Curriculum review circle - Research Paper Example The reviews may think they have all the time and end up taking a lot of time in the review process. Another major problem that is still notable with the LaCrescent-Hokah School District Curriculum Improvement Plan is the fact that the various stages at some point seem to overlap one another. The National Council for Curriculum and Assessment (1999) explained on the need to be able to distinguish the various stages in the review process. However for LaCrescent-Hokah School District, stages five and six seems to be similar. Almost same activities are carried out with the only distinction being the two parts. This makes it not so easy to distinguish which stage the review has reached. This may become difficult to determine the progress of the review. A look at the three programs however shows that there is some similarity in the way they are structured. The initial stages involve the determination of what is there at present. This is the data collection. The information obtained is then analyzed and reviewed to determine what needs to be added onto the curriculum. It’s tested for what is working and what is not with proper revision made on them. Then the proposals are implemented as planned. While this is taking place, issues that may arise are dealt with. What does not work is avoided while any revision necessary are made. Then full implementation is ensured. For the success of any change to be implemented in any organization or sector proper involvement of the stakeholders is absolutely import. The same case applies to the implementation of the Curriculum Review Cycle. The various stakeholders as identified by Office for standards in education (OFSTED), (1995) must all be brought on board the development and implementation process. The teachers whole are the leading implementers in the review process must be all provide with the knowledge,
Monday, February 3, 2020
Human Growth and development Essay Example | Topics and Well Written Essays - 250 words - 2
Human Growth and development - Essay Example Psychiatric evaluation of the parents of the infant should also be undertaken. History of behavioral problems such as delinquent behaviors, criminal cases, and substance abuse should also be checked in the family history since it had been determined that problematic behaviors are partly genetic. Determination of possible learning disabilities is also important to be able to be prepared for the time when the child needs to start education. There are other aspects that should be considered in adopting an infant such legal and social aspects. But the health and developmental factors related to the infant itself should be the primary consideration. In adoption of an infant, the adopting parents should have the proper attitude and preparedness. They should consider all the factors related to the health and capacity of the child. If they decide to overlook perceptible problems related to the health and behavior, based on family history, the future parents should be ready for possible conse quences since adoption is a lifetime decision.
Sunday, January 26, 2020
Neuropsychology: Overview, Applications and Analysis
Neuropsychology: Overview, Applications and Analysis Neuropsychology, the Newest Tool in Psychology Neuropsychology Andrew Davis Table of Contents (Jump to) 1) An Introduction 2) Neuropsychology as a new field 2.1) Key terms in Neuropsychology Clinical Neuropsychology Experimental Neuropsychology Cognitive Neuropsychology 2.2) the role that Neuropsychology plays 3) The history of Neuropsychology 4) The difference between fields related to Neuropsychology 5) Neuropsychology in South Africa 6) Relevance of Neuropsychology for Counsellors 7) Conclusion The author’s brain, and his thought processes Reference List 1) An Introduction Humans resist change. Humans resist the new. It is with the above mantra in mind, this text will explore Neuropsychology. Neuropsychology is one of the newest disciplines inside psychology, and therefore subject to wariness if not revulsion by those involved in psychology, due almost solely on its newness. Registered Counsellors in South Africa face an interesting dilemma – in an effort to be as effective as possible Neuropsychology must be utilized, however, its newness creates a problem. Re-educating counsellors costs time and money in a nation that cannot afford it, but not doing so leads to an almost unethical practice of wilfully excluding the usage of a tool that aids in one’s work. It is with this in mind that this text aims to provide an exploration of Neuropsychology in the following categories; Neuropsychology as a new field, important terminology in this field, the role that it plays, the history of Neuropsychology in short, differentiation of Neuropsychology and related disciplines, and finally an exploration of Neuropsychology within South Africa and its relevance to Registered Counsellors. A representation of the author’s brain and mental processes will also be included. 2) Neuropsychology as a new field Neuropsychology is a new field –even when compared to Psychology itself, a science that has only formally existed for little compared to other medical sciences- and so is associated with much confusion. An excellent and concise definition is that Neuropsychology is, â€Å"the scientific investigation of cognition, that is, of all mental abilities: perception, attention, learning, memory, processing of spoken and written language, thinking, reasoning and belief formation†(Coltheart, 2002:139). There are several terms in Neuropsychology that must be known. 2.1) Key terms in Neuropsychology As with most fields of science, there are numerous technical concepts and terms. The following terms are important if one wishes to become familiar at Neuropsychology, but pale in comparison to the more technical terms that a Neuropsychologists Clinical Neuropsychology Clinical Neuropsychology, â€Å"[I]s a specialty in professional psychology that applies principles of assessment and intervention based upon the scientific study of human behaviour [sic] as it relates to normal and abnormal functioning of the central nervous system†(American Psychological Association, 2010). Clinical Neuropsychologists are pre-occupied with normality and abnormity of the brain and spine with regards to psychological (mental) functioning, and how to correct the abnormal. This is the branch of Neuropsychology most involved in psychological illness and damage. Experimental Neuropsychology Experimental Neuropsychology is occupied with the researching of cognition and behaviour (All Psychology Careers, n.d.). As with all science, Experimental Neuropsychology provides the research, studies, and empirical observations that validate the theory throughout psychology as a whole. Experimental Neuropsychology is therefore of paramount importance in Neuropsychology, as it provides the basis for theories. Cognitive Neuropsychology Cognitive Neuropsychology is focused on hew the specifics of the brains form and functions translates into mental (psychological) processes. 2.2) the role that Neuropsychology plays 3) The history of Neuropsychology Although the relation between the mind and a ‘thinking-organ’ (once thought of the heart, but many times as the brain) and behaviour, cognition, and emotion have been known and explored for millennia, from philosophers, holy men, and apothecaries, to physicians and healers (Stanley, 2000) it is only since the middle of the nineteenth-century that Neuropsychology has been scientifically defined (Hallett, n.d.). The now famous Broca, Wernicke, and Dax were the first to observe an empirical link between damage to specific areas of the brain and the disruption of speech (as well as comprehension of speech (Hallett, n.d.,; Banich Compton, 2011). Once empirical science was first used it has become both the de jure and the de facto means in which theory and practice regarding Neuropsychology have been linked. No longer did theory disregard observation. Due to the limitation of equipment, there was little progress in Neuropsychology until the development of brain-imaging technology, as only autopsies could conclusively be used to observe most types of brain damage. This technological disadvantage acted in conjunction with the rise of the behavioural perspective of Psychology to place Neuropsychology out of favour (Coltheart,2008) . Once magnetic resonance imaging (MRI) was invented – followed quickly by functional magnetic resonance imaging (fMRI)- was developed, the cognitive sciences advanced again, thus allowing the activity of the brain to be viewed while the observed was conscious and thinking, or moving. This allowed real-time comparison between the brain, thoughts and actions (All Psychology Careers, n.d. 2) 4) The difference between fields related to Neuropsychology There is a large amount of overlap with Neuropsychology and the medical (more physically minded) cognitive sciences. These differences must be known so as to avoid confusion. Cognitive Neuroscience, is different from Neuropsychology in that although the two disciples are involved in brain-damage and the information related to it, Cognitive Neuroscience focuses on the underlying neural mechanism that lies below cognition (Daniel, 2000) Cognitive Science, is different from Neuropsychology 5) Neuropsychology in South Africa South Africa has an independent institution regarding Neuropsychology, the South African Clinical Neuropsychological Association (SACNA) which aims to, â€Å"promote and stimulate interest in the field of neuropsychology, while maintaining standards in neuropsychological practice. This is achieved by ensuring that its full members have demonstrated knowledge and competence in the field, by way of examination and peer review†(SACNA, n.d.). The organization’s website provides links for psychologists to become part of the organization and all the benefits that it entails, as well as provide educational workshops (SACNA, n.d.). The website also provides a means to â€Å"find†a Neuropsychologist (SACNA, n.d.). South Africa’s status as a developing nation translates into a lack of funding for social services, as well as a lack of disposable income to pay for services. Therefore, the number of specialists such as Neuropsychologists is low, but the number of Registered Counsellors is higher, but still low compared to the ideal – an ideal where there was never a lack of mental health experts for those in need. 6) Relevance of Neuropsychology for Counsellors In the South African context, registered counsellors act within the role of gatekeepers to psychological support. In short, if a counsellor cannot support a client due to the client presenting issues and problems outside of the limited remit of counselling, the counsellor will then decide who to refer their clients to so that experts in specific psychological fields. Therefore, it is of paramount importance that counsellors be educated with enough of these more specialist fields so that a full decision on referral is made with the fullest amount of knowledge to back it. As counsellors act as ‘gatekeepers’, specialists are kept protected from overwork. This is due to the fact that a lower bar of entry (not necessarily a negative thing) for counsellors translates to there being a larger number than more specialist psychological health professionals – who are fewer in number, and able to treat few people. 7) In conclusion Neuropsychology is an interesting and powerful new part that resides in Psychology as a whole, but is related to Cognitive Neuroscience, Cognitive Science in a way that bridges the physical and the mental. It is the bridge that connects two, once separate, worlds. Neuropsychology is not only the domain of expert specialists, but should also count all mental health professionals as part of it. Due to the relatively tiny amount of Neuropsychological specialists registered counsellors must act as gatekeepers – referring those who require Neuropsychological aid to Neuropsychologists, and referring or keeping those who require different help. The author’s brain, and his thought processes Reference List All Psychology Careers. (n.d. 1). What is Experimental Neuropsychology?. Retrieved 6 April, 2015 from http://www.allpsychologycareers.com/topics/experimental-neuropsychology.html All Psychology Careers. (n.d. 2). Cognitive Neuropsychology. Retrieved 6 April, 2015 from http://www.allpsychologycareers.com/topics/cognitive-neuropsychology.html American Psychological Association. (2010). Clinical Neuropsychology. Retrieved 6 April, 2015 from http://www.apa.org/ed/graduate/specialize/neuro.aspx Banich, M.T., Compton, R.J. (2011). Cognitive Neuroscience: International edition (Third ed.).Wadsworth: Cengage Learning. Coltheart, M. (2002). Cognitive neuropsychology. In Wixted, J. (Ed.) Stevens Handbook of Experimental Psychology, Third Edition Volume 4: Methodology. John Wiley Sons, pp 139-174. Coltheart, M. (2008). Cognitive neuropsychology. Retrieved 6 April, 2015 from http://www.scholarpedia.org/article/Cognitive_neuropsychology Daniel, L.S. (2000). Understanding Implicit memory: A cognitive neuroscience approach. In Gazzaniga, M.S. Cognitive Neuroscience: A Reader. Wiley Hallett, S. (n.d.). Neuropsychology. Retrieved 6 April, 2015 from http://www.rcpsych.ac.uk/pdf/semBasNeuro_chapter5.pdf SACNA. ( n.d.). South African Clinical Neuropsychological Association. Retrieved 5 April, 2015 from http://www.sacna.co.za/ Stanley, F. (2000). Minds behind the Brain: A history of the pioneers and their discoveries. London: Oxford University Press.
Saturday, January 18, 2020
Regression Analysis and Marks
BRUNEL UNIVERSITY Master of Science Degree examination Specimen Exam Paper 2005-2006 EC5002: Modelling Financial Decisions and Markets EC5030: Introduction to Quantitative Methods Time allowed: 1. 5 hours Answer all of question 1 and at least two other questions 1. COMPULSORY Provide brief answers to all the following: (a) A sample of 20 observations corresponding to the model: Y = + X + u, gave the P P P following data: (X X)2 = 215:4, (Y Y )2 = 86:9, and (X X)(Y Y ) = 106:04. Estimate . 5 marks) (b) Prove that r2 = byx bxy , where byx is the least-squares (LS) slope in the regression of Y on X , bxy is the LS slope in the regression of X on Y , and r is the coe? cient of correlation between X and Y . (5 marks) (c) Present four alternative in†¡ ation/unemployment regressions. (5 marks) (d) Give one reason for autocorrelated disturbances. (5 marks) (e) Explain how we might use the Breusch-Godfrey statistic to test estimated residuals for serial correlation. (5 marks) (f) The fol lowing regression equation is estimated as a production function for Q: lnQ = 1:37 + 0:632 lnK + 0:452 lnL, cov(bk ; bl ) = 0:055; 0:257) (0:219) where the standard errors are given in parentheses. Test the hypothesis that capital (K ) and labor (L) elasticities of output are identical. (5 marks) Continued (Turn over) 1 ANSWER TWO QUESTIONS FROM THE FOLLOWING: 2. (a) Economic theory supplies the economic interpretation for the predicted relationships between nominal (in†¡ ation) uncertainty, real (output growth) uncertainty, output growth, and in†¡ ation. Discuss †¦ve testable hypotheses regarding bidirectional causality among these four variables. (25 marks) + yt b) An investigator estimates a linear relation for German output growth (yt ): yt = 1 + ut , t = 1850; : : : ; 1999. The values of †¦ve test statistics are shown in Table 1: Discuss the results. Is the above equation correctly speci†¦ed? (10 marks) 3. (a) i) Show how various examples of typical hyp otheses †¦t into a general linear framework: Rb = r, where R is a (q k) matrix of known constants, with q < k, b is the (k 1) least-squares vector, and r is a q -vector of known constants. ii) Show how the least-squares estimator (b) of about . an be used to test various hypotheses iii) â€Å"The test procedure is then to reject the hypothesis Rb = r if the computed F value exceeds a preselected critical value†Discuss. (20 marks) (b) The results of least-squares estimation (based on 30 quarterly observations) of the regression of the actual on predicted interest rates (three-month U. S. Treasury Bills) were as follows: rt = 0:24 + 0:94 rt + et ; RSS = 28:56; (0:86) (0:14) where rt is the observed interest rate, and rt is the average expectation of rt held at the end of the preceding quarter.FiguresX parentheses are estimated standard errors. in X (rt r )2 = 52. The sample data on r give rt =30 = 10, According to the rational expectations hypothesis expectations are unbi ased, that is, the average prediction is equal to the observed realization of the variable under investigation. Test this claim by reference to announced predictions and to actual values of the rate of interest on three-month U. S. Treasury Bills. (Note: In the above equation all the assumptions of the classical linear regression model are satis†¦ed). 15 marks) Continued (Turn over) 2 4. (a) What are the assumptions of the classical linear regression model? (10 marks) (b) Prove that the variance-covariance matrix of the (k 1) least-squares vector b is: var(b) = 2 (X 0 X) 1 , where 2 is the variance of the disturbances and X is the (n k) matrix of the regressors. (15 marks) b (c) In the two-variable equation: Yi = a+bXi , i = 1; : : : ; n show that cov(a; b) = 2 X= X)2 . (10 marks) X (X 5. (a) Explain how we might use White statistic to test for the presence of heteroscedasticity in the estimated residuals. 10 marks) (b) A speci†¦ed equation is Y = X +u, with E(u) = 0 and E (uu0 ) = ; where =diagf 2 ; : : : ; 1 Derive White’ correct estimates of the standard errors of the OLS coe? cients. s (15 marks) (c) Explain how we might test for ARCH e ¤ects? (10 marks) 2 2g . 3 Table 1. Test statistic Value of the test p-value White heteroscedasticity test 50. 72 0. 00 Box-Pierce Statistic on 82. 263 0. 00 Squared Residuals Jarque-Bera statistic 341. 754 0. 00 ARCH test 65. 42 0. 00 Ramsey test statistic 39. 74 0. 00 4
Friday, January 10, 2020
The changes in the global pattern of tourism
The global pattern of tourism has changed drastically over the last fifty years. Changes such as the number of global tourist arrivals, distances travelled, and the cost of travel have meant that ‘tourism' is today one of the world's most important industries. There are a number of reasons for this change, for example, technology and social situation. In the seventeenth century, doctors recommended benefits of water, which triggered the building of spas. People began taking relaxing trips to these spas. When the industrial revolution struck, huge changes in transport took place, such as better rail links in the United Kingdom. These railway lines provided links to expand. Also, people began to earn more money, and with disposable income, annual holidays became increasingly popular. During World War 2, people were not allowed on beaches. Once the war had finished, people celebrated by going to the beach. This made seaside resorts become much more popular. In 1970, the jet plane carried 307 million passengers. By 2006, this had increased to a huge 2. billion! This shows just how much tourism has increased in the past half century. In 1950, international tourist arrivals were only 20 million. In 2005, it was measured to be over 700 million! Europe in particular was responsible for a considerable amount of this increase, approximately 400 million. In 2005, there were 441,528 thousand international tourist arrivals. The Mediterranean was responsible for 36% of this number. This shows that southern Spain is a very popular tourist destination. I think this is due to the climate in the Med. The Mediterranean is well known for its hot, dry summers, which naturally attract visitors. Most arrivals here are on holiday for leisure purposes, rather than business. It is not just in Europe, however, that tourism has increased. In 1990, the world saw 439 million international tourist arrivals. In 2005, this has increased to 806 million. This shows an average annual increase of 3. 3%. There are many reasons for this increase. Economic factors, such as rising incomes, decreasing costs of the flight itself – due to the expansion of budget airlines. Also, many airlines have introduced reward schemes, or loyalty bonuses, which are appealing to the customer. Social factors, such as the increase of the number of days paid leave workers can take. This gives people more spare time for a holiday. Many students in recent years, after finishing school, which to take a ‘gap year' to go travelling, before going to university, or getting a job. Finally, there are also political reasons for which tourism has increased. Some governments invest heavily in advertising campaigns to encourage tourism. Also, international sporting events, such as the world cup or the Olympics, attract millions of people from all over the globe. Forecasts from the World Tourism Organisation are showing an approximate 650 million increase in global arrivals between 2007 and 2020. Another noticeable change is the distance people are travelling to go on holiday. In 1841, Thomas cook introduce the first ever package holiday, from Leicester to Loughborough, which was only 12 miles away. These travellers attended temperance meetings. Fifty years ago, tourist arrivals in the Middle East and Africa were virtually none existent, as the travel links simply were not there. I believe one of the main reasons that tourist arrivals have gone up so considerably is due to the travel links expanding. Thanks to the invention of the train, Thomas Cook was able to expand his holidays. However, in 1970, with the invention of the jet plane, mass tourism began. There was no limit to where people could go on holiday, so the distances travelled dramatically increased here. People travel to places such as Spain, specifically the Mediterranean, as it is only 725 miles, which is approximately a 2 hour flight. Today; people can travel literally across the world, from London to Sydney, a distance of 10,552 miles. The third main change in the pattern of tourism over the last fifty years is the cost of travel. People first began taking holidays after the industrial revolution, as they had disposable income. Although prices for travel such as trains were cheaper in the 1950's, people have a much higher income in today's society, so they are much more affordable. In the early 1990's, the first budget airline was introduced. They offered low cost flights in exchange for passenger services, such as in-flight meals and extra leg room. This appealed to many working class people, who wished to go on holiday for less. Flights on budget airlines can be extremely cheap, especially if you fly on an unpopular time and date. You can purchase some flights from the UK to Ireland as cheap as 1p plus VAT. Return flights to Spain can be as cheap as i20. Package holidays also made holidays more appealing to people who were not as well off as some. They combine the cost of flight, accommodation and travel, and are usually with a group of several other tourists. Package holidays range from your typical relaxing fortnight on the beach in Majorca, to cockroach races in Brisbane! At the story bridge hotel in Brisbane, every January 26th, they race cockroaches! This tradition began in 1981, when to drunken men argued that the cockroaches from their part of town were fastest. Today, people literally come from all over the world just to race there cockroaches! Also, many people today choose to go on â€Å"all inclusive†holidays. This is when the holiday resort provides all food and drink in the price. This is appealing to people as when on holiday, many people do not wish to cook or worrying about finding places to eat. All inclusive holidays start from just i290 to Ibiza; this makes luxury more affordable for the working class. Recently, ecotourism has become more popular. This is when people travel to less economically developed countries such as Kenya, or India. They volunteer once in the country, often doing conservation work. Flights to these areas are not very expensive, as they are less popular. Fifty years ago, few people travelled far to go on holiday, as it was so expensive. Overall, these are the three key changes in the pattern of tourism. A dramatic increase in the number of global tourist arrivals, an increase in the distance travelled, and cost of travel being more affordable, have meant that tourism is very different today than it was fifty years ago. I feel that the main catalyst for increasing tourism in general, was the invention of the jet plane. Carrying 2. 1 billion passengers in 2006, it is clearly responsible for a large part of transporting these tourists. Of course, another reason for the patterns in tourism is the fact that people are earning more money. Thanks to this disposable income, more people can afford to treat themselves to a holiday. I also feel there are now more incentives to go on holiday today, such as these â€Å"package†, or â€Å"all inclusive†holidays, as these save the consumer money. Fifty years ago, people used to travel 12 miles down the road to go on holiday, today they travel to the other side of the world. I feel this shows just how big these changes in the pattern of tourism are.
Thursday, January 2, 2020
Case Study on a Child with Obsessive-Compulsive Disorder
London, a 10 year old student, displays an inability to complete work and tasks in a timely manner at home and school. Her obsessive thoughts and compulsions have led to her ostracization in the classroom and a strained relationship with her mother. Due to her compulsion to repeat activities ten times and inability to control her thoughts, a diagnosis of Obsessive-Compulsive Disorder was established. London will be treated using the Cognitive Behavioral approach as it is recommended for children by the American Academy of Child Adolescent Psychiatry (Freeman et al., 2007). Heavy emphasis will be placed on the inclusion of London’s mother and grandmother in and out of therapy sessions. Over the course of treatment, London will engage in relaxation techniques, rational emotive therapy, and exposure and ritual prevention therapy. Before beginning any type of intervention, London will be evaluated with the Children’s Yale-Brown Obsession Compulsion Scale Severity Rating Scale to obtain a baseline. This scale will be utilized periodically throughout treatment to measure effectiveness and progress. Having established the starting point, London’s mother and grandmother will be asked to participate in a session. In addition to discussing the diagnosis and approving of the treatment plan, the importance of the family unit will be expressed. A discussion about ways to cope with London’s behaviors will be a primary objective as high levels of expressed emotion have aShow MoreRelatedObsessive Compulsive Disorder (OCD) Essay1627 Words  | 7 PagesSeveral mental health disorders are brought on due to both psychological and biological problems. Many of these are anxiety or behavioral disorders. Obsessive Compulsive Disorder (OCD) is one of these disorders that is an issue in both anxiety an d behavioral issues. 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