Bronchiectasis-Revisited Essays - Respiratory System, Medicine

Bronchiectasis-Revisited Essays - Respiratory System, Medicine Bronchiectasis-Revisited K. Neelakantan Viswanathan Introduction: Bronchiectasis is a common chronic lung disease characterized by a "vicious cycle" of infection, inflammation and irreversible destruction in the airway (4). Laennec in 1819 defined bronchiectasis based on the findings in an infant who died of whooping cough."Bronemon" in Greek means the windpipe and "ektasis" means stretched out or extension (9).Bronchiectasis is a pathological, irreversible dilatation of the proximal, medium sized and terminal airways more than 2 mm in size, the 4th to the 10th generations being involved (10). Pathology: The normal bronchial wall consisting of cartilage, muscle and elastic tissue gets destroyed and is replaced by fibrous tissue. There is chronic,recurrent infection of secretions that pool within the airways. The organisms produce pigments, proteases and other toxins impairing mucociliary clearance. Epithelial injury is induced by the host inflammatory response, largely due to neutrophil-released mediators and protection against infection is compromised. There is also bronchial and peribronchial inflammation and fibrosis, bronchial wall ulceration, squamous metaplasia and mucous gland hyperplasia. The pulmonary parenchyma supplied by. The abnormal airways contain areas of fibrosis,emphysema,bronchopneumonia and atelectasis in varying combinations (1). The bronchiectatic cavities may be lined by granulation tissue,squamous epithelium or normal ciliated epithelium(6).Bronchiectasis may be accompanied by massive collapse in which all the airways and alveoli distal to the site of collapse are deflated resulting in an airless lobe (13).Reid's Classification (1950) divides this entity into saccular (cystic), fusiform (cylindrical) and varicose types (7). In addition there are follicular, nodular and traction types. There is transmural inflammation and mucosal oedema in cylindrical types, cratering and ulceration in cystic types with bronchial arteriole neo-vascularisation and distortion due to scarring or obstruction from repeated infections in the varicose types (4). In traction types there is extensive volume loss of lung bringing the upper and lower parts of the spine together with concavity to the affected side. Bronchiectasis commonly affects lower lobes, the left more frequently than the right. Next in frequency are the right middle lobe and the lingual (8). The apical segment is spared (12).Aspiration commonly affects the right lung and the lower lobes or the posterior segment of the upper lobes (4).Bronchiectasis sicca involves the upper lobes and is characterized by haemoptysis instead of sputum production, the aetiology, most often, being tuberculosis. Cystic fibrosis and allergic bronchopulmonary aspergillosis (ABPA) also affect the upper lobes.ABPA produces proximal or central (perihilar) bronchiectasis involving 4th-7th generations. Nodular bronchiectasis occurs in Mycobacterium avium infections. It is common in white women aged 55 and above with chronic cough with middle lobe or lingular involvement (4). Pseudo bronchiectasis occurs in expansion of a collapsed lung, usually after pneumonia. Aetiology: The causes of bronchiectasis may be easily remembered as follows: Bordetella pertussis infections Respiratory syncitial virus, Rheumatoid arthritis,Riley -Day syndrome,Relapsing polychondritis Obstruction by foreign body Neoplastic / Nodal compression Chagas disease Hypogammaglobulinaemia (especially selective deficiency of IgG2), HIV infection,Herpes simplex,Histoplasmosis Influenza,Inflammatory bowel diseases,Interstitial lung disease (fibrosing alveolitis) Exanthems-measles, mumps Cystic fibrosis, Congenital sequestrated lung. Coeliac disease, Ciliary dyskinesia (primary), in which the respiratory mucosal biopsy shows broken or missing ciliary spokes Tuberculosis,Toxins- ammonia, paraquat Aspiration of gastric contents,Alcoholism,Adenovirus infections,Alpha-1- antitrypsin deficiency,Atypical Mycobacteria (avium),Atypical pneumonia( Mycoplasma), Allergic bronchopulmonary aspergillosis (ABPA) Systemic complement deficiencies, Sjogren's syndrome,Sarcoidosis Idiopathic (commonest) Syndromes associated with bronchiectasis Kartagener's syndrome: an autosomal recessive' disorder, described in 1933 by a pediatrician, characterized by situs inversus, frontal sinusitis or agenesis of frontal sinuses and bronchiectasis. It is also associated with immotile cilia, due to an abnormal protein involved in the modified ciliary motility causing absence or aberrance of dynein arms, and hence persons with Kartagener's syndrome are infertile. The situs inversus is the chance result of embryonic migration of viscera rather than the normal cilia- dependent placement of internal organs (12). . Young's syndrome: characterized by obstructive azoospermia as a result of enlarged, palpable and obstructed epididymal head and obstruction by inspissated secretions (2). Williams Campbell syndrome: characterized by expiratory collapse of proximal airways on bronchoscopy. There is generalized bronchial cartilage deficiency leading to bronchomalacia. Mounier-Kuhn syndrome: characterised by congenital deficiency of bronchial cartilage associated with tracheobronchomegaly. Enlargement of the airways and deep corrugations produced by the redundant musculo-membranous tissues between the cartilaginous rings gives roentgenographic appearance of multiple diverticulae on CT (lO). Brock's syndrome: characterized by right middle lobe collapse, the bronchiectasis being caused by a foreign body or enlarged lymph node, usually tuberculous. Chandra- Khetarpal syndrome:characterized by levocardia, bronchiectasis and frontal sinusitis. Ciliary dysfunction is not a feature of this syndrome (3). MacLeod's (Swyer-James)syndrome: in which the disease is associated with a unilateral hyperluscent lung and characterized by brochiolitis obliterans (4). Yellow nail syndrome: associated with lymphedema and pleural effusion due to hypoplastic lymphatics. Childhood pentad of bronchiectasis:Whooping cough, measles, mumps, influenza, and primary complex are considered to be childhood infections that predispose to bronchiectasis in adult life. Clinical Features: Persons with bronchiectasis bring out copious foul smelling khaki-coloured sputum

The French Revolution, Its Outcome, and Legacy

The French Revolution, Its Outcome, and Legacy The outcome of the French Revolution, which began in 1789 and lasted for more than a decade, had numerous social, economic, and political effects not just in France but also in Europe and beyond.   Prelude to Revolt By the late 1780s, the French monarchy was on the brink of collapse. Its involvement in the American Revolution had left the regime of King Louis XVI bankrupt and desperate to raise funds by taxing the wealthy and the clergy. Years of bad harvests and rising prices for basic commodities led to social unrest among the rural and urban poor. Meanwhile, the growing middle class (known as the bourgeoisie) was chafing under an absolute monarchical rule and demanding political inclusion. In 1789  the king called for a meeting of the Estates-General- an advisory body of clergy, nobles, and bourgeoisie that had not convened in more than 170 years- to garner support for his financial reforms. When the representatives assembled in May of that year, they couldnt agree on how to apportion representation. After two months of bitter debate, the king ordered delegates locked out of the meeting hall. In response, they convened on June 20 on the royal tennis courts, where the bourgeoisie, with the support of many clergy and nobles, declared themselves the new governing body of the nation, the National Assembly, and  vowed to write a new constitution. Although Louis XVI agreed  in principle to these demands, he began plotting to undermine the Estates-General, stationing troops throughout the country. This alarmed the peasants and middle class alike, and on July 14, 1789, a mob attacked and occupied the Bastille prison in protest, touching off a wave of violent demonstrations nationwide. On Aug. 26, 1789, the National Assembly  approved the Declaration of the Rights of Man and of the Citizen. Like the Declaration of Independence in the United States, the French declaration guaranteed all citizens equal, enshrined property rights and free assembly, abolished the absolute power of the monarchy and established representative government. Not surprisingly, Louis XVI refused to accept the document, triggering another massive public outcry. The Reign of Terror For two years, Louis XVI and the National Assembly co-existed uneasily as reformers, radicals, and monarchists all jockeyed for political dominance. In April 1792 the Assembly declared war on Austria. But it quickly went badly for France, as Austrian ally Prussia joined in the conflict; troops from both nations soon occupied French soil. On Aug. 10, French radicals took the royal family prisoner at Tuileries Palace. Weeks later, on Sept. 21, the National Assembly abolished the monarchy entirely and declared France a republic. King Louis and Queen Marie-Antoinette were tried hastily and found guilty of treason. Both would be beheaded in 1793, Louis on Jan. 21 and Marie-Antoinette on Oct. 16. As the Austro-Prussian war dragged on, the French government and society, in general, were mired in turmoil. In the National Assembly, a radical group of politicians seized control and began implementing reforms, including a new national calendar and the abolition of religion. Beginning in September 1793, thousands of French citizens, many from the middle and upper classes, were arrested, tried, and executed during a wave of violent repression aimed at the Jacobins opponents, called the Reign of Terror.   The Reign of Terror would last until the following July when its Jacobin leaders were overthrown and executed. In its wake, former members of the National Assembly who had survived the oppression emerged and seized power, creating a conservative backlash to the ongoing French Revolution. Rise of Napoleon On Aug. 22, 1795, the National Assembly approved a new constitution that established a representative system of government with a bicameral legislature similar to that in the U.S. For the next four years, the French government would be beset by political corruption, domestic unrest, a weak economy, and ongoing efforts by radicals and monarchists to seize power. Into the vacuum strode French Gen. Napoleon Bonaparte. On Nov. 9, 1799, Bonaparte backed by the army overthrew the National Assembly and declared the French Revolution over. Over the next decade and a half, he could consolidate power domestically as he led France in a series of military victories across much of Europe, declaring himself emperor of France in 1804. During his reign, Bonaparte continued the liberalization that had begun during the Revolution, reforming its civil code, establishing the first national bank, expanding public education, and investing heavily in infrastructures like roads and sewers. As the French army conquered foreign lands, he brought these reforms, known as the Napoleonic Code, with him, liberalizing property rights, ending the practice of segregating Jews in ghettos, and declaring all men equal. But Napoleon would eventually be undermined by his own military ambitions and be defeated in 1815 by the British at the Battle of Waterloo. He would die in exile on the Mediterranean island of St. Helena in 1821. Revolutions Legacy and Lessons With the advantage of hindsight, its easy to see the positive legacies of the French Revolution. It established the precedent of representational, democratic government, now the model of governance in much of the world. It also established liberal social tenets of equality among all citizens, basic property rights, and separation of church and state, much as did the American Revolution.   Napoleons conquest of Europe spread these ideas throughout the continent, while further destabilizing the influence of the Holy Roman Empire, which would eventually collapse in 1806. It also sowed the seeds for later revolts in 1830 and 1849 across Europe, loosening or ending the monarchical rule that would lead to the creation of modern-day Germany and Italy later in the century, as well as sow the seeds for the Franco-Prussian war and, later, World War I. Sources Editors of the Encyclopaedia Brittanica. French Revolution. 7 February 2018.History.com staff. French Revolution. History.com.The Open University staff. French Revolution. Open.edu.Roy Rosenzweig Center for History and New Media staff. Legacies of the Revolution. chnm.gmu.edu.

The Mass Transit Railway Corporation and Miami Metrorail Essay

The Mass Transit Railway Corporation and Miami Metrorail - Essay Example The researcher states that the trains give administrations concealed in numerous different frameworks around the globe: stations have open machines, wheelchair and stroller availability (and the space inside the train to store them), glass entryways obstructing the tracks, and interoperable touch-and-go passage installment. However, following three many years of operation, the framework developed to only 25 miles, added stand out line to MIA and has never conveyed 200,000 riders day by day. Metrorail has not conveyed the guarantees of its initial advocates. Indeed, as Metrorail gets to be more important, it is doubtful that any more lines will be fabricated at whatever time soon. The province does not have the countless dollars important to manufacture such extravagant ventures. Likewise, the national government, which generally has financed huge transportation, undertakings fails to offer intention to help frameworks, for example, Metrorail grows. As an issue, Metrorail will likely remain a two-line framework for a considerable length of time to come. Support and upgrades ought to guarantee at any rate an additional 30 years of operation. Metro assembled heading masters in land, transportation, and metropolitan financing from academe, administration counseling, strategy backing, and government to request the best thoughts for creative methods for tending to Metros test. Educated by our companions and nearby execution measures, Metro is creating rules that the area can use to advise improvement of high limit travel ventures (Benson 1998). Actually, because of the expense connected with Metrorail extension alongside existing area utilizes and constructed environment as a part of a great part of the district, the majority of our future high limit travel ventures will be comprised of other travel modes. Metro needs to enhance the limit at over twelve stations: some of these stations are at limit today, and its complete eight-auto train project will bring many more clients to effectively gathered stations. The organization needs to construct new elevators, extend mezzanines, and assemble walker paths to take care of this future demand.

Are nurses as cost effective as doctors in urgent care centres UK Essay

Are nurses as cost effective as doctors in urgent care centres UK - Essay Example Most hospitals and other medical facilities in London and elsewhere across the country have successfully commissioned or are on the verge of commissioning service models related to urgent care centers, especially at the frontage of the emergency departments. In particular, the urgent care centers provide appropriate response to patients with minor injuries and illnesses that do not require specialized or intensive care. In addition, urgent care centers foster greater integration between urgent services delivered in communities and care services provided in hospitals. Incidentally, most primary care practitioners have stronger links with community services thus enhancing rapid and seamless transfer of patients to relevant pathways (Healthcare for London 2010, p. 29). These care centers have also facilitated integration of the provisions of emergency and urgent care. Virtually all the studies indicated that nurse practitioners provide quality medical care services at comparatively lowe r costs, as well as provide more disease prevention counseling, health promotion activities, health education, and successfully achieve higher levels of patient satisfaction than doctors. According to the National Institute for Health Research (March, 2014), the effectiveness of nurses or nurse practitioners would only be compared with that of junior doctors in relation to treating of patients with minor injuries in urgent care centers and emergency department settings (National Institute for Health Research 2014, p. 5). However, the study offered limited evidence that could prove that nurses reduced the waiting time for patients during assessment or even treatment, as well as patients’ overall length of stay in urgent care centers and emergency departments in entirety. In addition, the study revealed that most patients were satisfied with the nurse practitioner’s high levels of acceptance

An Introduction to Plastic Gears :: essays papers

An Introduction to Plastic Gears As an employee of a world-class plastic gear manufacturer for many years, I see how this is an undeniably growing part of the gear industry. I hope to briefly describe how something seemingly simple as a plastic gear requires the culmination of many very state-of-the-art processes. Within one word I’ll say that at every level precision is required. Initially, a gear engineer must design a gear that meets the design intent while remaining cognizant of all variables that result from using materials such as plastic. This engineer must design a gear electrode that will actually determine the form of the gear. This electrode is then burned into the mold cavity using a method commonly referred to as EDM or electrical discharge machining. It is essential that the gear electrode be cut identical to the finished gear tooth form. Some compensation is normally made for the shrinkage of plastic as well as the overburn that occurs during the EDM process. The gear engineer normally will alter the gear tooth geometry to relieve stress and strengthen the gear tooth form. This alteration is normally done at the base or root of the gear tooth and at the tip or peak of the tooth. Next, a mold maker then will evaluate what the expected life of the gear program will be so that he can build a mold that is robust and capable producing the many millions of parts with the highest of accuracy. He will ensure that the plastic that will be entering the mold will travel along balanced pathway or runner system that will allow for consistent fill into each mold cavity. His tool for evaluating this flow is done through a computer model commonly referred to as mold flow analysis. He must be capable of understanding what makes a good mold as well as a good gear. Once the mold is completed it is then set into an injection-molding machine. It is important in the precision gear molding industry that the molding unit has a highly controlled system in place to monitor the molding process. It is equally important during this process that there is a means by which all peripheral variables can be controlled. This is done utilizing a central processor, which will maintain balance on all settings for every parameter. Transducers relay all of their information into a central processor that will monitor and maintain this consistent process.

Bayfield Mud Company Essay

The Bayfield Mud Company has had some problems with their 50 pound bags of treating agents. They sent shipped some bags to Wet Land Drilling, Inc. that were found to be short-weight by approximately 5%. Wet Land first did their own research on how many bags were short and by how much. They randomly sampled 50 bags and found the average net weight to be 47.51 pounds. Wet Land then contacted Bayfield Mud about the situation. Bayfield gave a 5% credit to Wed-Land for the mistakes. But We Land not completely satisfied with the credit because the errors in the weight of the bags could impact their operations. Wet Land informed Bayfield Mud that if something like this happened again, they would take their business elsewhere. Bayfield’s response to all this was to expand a one-shift to a two-shift operation. Then, they had to expand to a three-shift operation. The additional night-shift bagging crew consisted of all new employee. The most emphasis was placed on increasing output. It was very likely that only occasionally were bags double checked on their weight. This is where the statistical control has come into place. The problem that Bayfield Mud faces includes the possibility of losing a customer in Wet Land, Inc. Another problem is putting out a product that is not acceptable. This problem could lead to more than just the loss of one customers, but perhaps an even greater amount. Based on the information given in the following charts and numbers, especially the control chat, it is obvious that the bag problem is out of control. Out of the 72 times that samples were taken, 14 were out of control. That is unacceptable for a company who intends on satisfying the customer and maintaining business. Something must be done in this company to correct the problem that has arisen. I think if the company still getting the more products but sacrifice the quality, the problem cannot not be solved actually. The company needs to ensure that the bag really does weigh 50 pounds. If they are going to offer a 50 pound product, then make it 50 pounds. It seems that the times that most of the bags are less than 50 pounds are around the nighttime shifts. Also, the times that it seems more bags are over 50 pounds are during the daytime shifts. They need to develop a y to ensure the accuracy of weighing the bags. Whatever they would  implement would have to increase quality, while not impacting the output numbers. There is a large demand for their product, so they must be able to meet the demand. And Bayfield needs to change their strategy or even do an entire makeover of their management team in order to get a better way for developing. Feng Bing (Yvonne) Student ID: 11-613222

Chapter 5 Of The Windows Internals Textbook - 1076 Words

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