My Daughter Azul Essay Example for Free

My Daughter Azul Essay I’m not speaking about the blue color, even though â€Å"azul† means blue, this time I talking about my daughter, my little piece of blue sky named Azul. I have a wonderful family; we are all Mexican, my husband, Jose; my little men, Pepito; and my beautiful daughter, Azul. I’m proud of my daughter because she is a brilliant student, a very happy girl, and a great sister. Azul is well known in her school for being a wonderful learner. She won â€Å"Student of the Month† twice last year, this might sound like â€Å"Is not a big deal†, but consider that last year, while we were living in Mexico, she didn ´t know a word about English and now she is earning all kind of awards in a language that is not her mother tongue. Her teacher says that she works in class as a bee. She gets up really early to get ready for school, sometimes she asks me to go to wait for the bus twenty minutes before the bus arrives, she really enjoys going to school. My daughter is a very joyful girl, she sings and dances all the time, every afternoon she steps in front of the TV and looks at music videos to dance and sing with her friends, they look at her like a rock star and all laugh between songs and dancing moves. Is amazing how she makes fun of nothing at all; she’s as happy as the day is long. These good qualities are not even the half when you compare them to her value as a sister. She takes care of Pepito whenever I ask her to do it. She comforts and huge to him when she sees him crying. She could spend all day playing, running, and having fun with him. All these things might sound like the kind of things that any older sister does with her younger brother, but what I really think that makes a real difference is the fact that Azul knows how hard it can be when you arrive to any place and you don’t understand anything about they are saying, that’s why she really cares about teaching to her baby brother with love to speak in both languages, English and Spanish. That’s why I’m really happy and proud of my daughter and I know that she will have a brilliant future in many ways. I wish she always be happy and her smile remains forever.

With reference to An Arrest and An occurance at Owl Creek bridge Essay

With reference to An Arrest and An occurance at Owl Creek bridge Explore Ambrose Beirce's treatment of the theme of justice. Leann Parker With reference to 'An Arrest' and 'An occurance at Owl Creek bridge' Explore Ambrose Beirce's treatment of the theme of justice. Ambrose Beirce lived between the years of 1842 - 1914 ,though his date of death can not be for certain. He lived during the period of the civil war and was the author of supernatural stories. He wrote those stories because he was interested in the war and crime and this led too his two books; 'Tales of soldiers and civilians' and 'Can such things be?'. Justice also played a huge part in Beirce's opinion. He believed that justice had changed during the Civil war and that what was happening was somewhat unfair. He expressed this in a way to make us feel sympathetic. In each state their were different laws ,something you could do in Kentucky you might not have got away with in New York City ,justice was givenfor many different reasons. Law during the Civil warwas very different and the sheriffs (not police) found keeping Law and order very difficult. The two main stories he wrote about were 'An Arrest' and 'An occurance at Owl Creek bridge'. Beirce wrote his stories on the theme of justice and he done this because he wanted to explore the mind and feel hope and peace. The first story 'An Arrest' is about a man Orrin Brower , a fugitive on the run. He was sent to prison for murdering his brother-in-law and has longed for freedom ever since. He eventually manages to escape and runs into the forest but gets lost. He finally makes his way onto a road but on the other side spots a figure of justice who takes him back to the jail but on... ...help out, farquhar thinking he was on his side, he is then hung for doing something bad but his last 3 seconds turn into a lifetime before he is actually hung. Ambrose Beirce chose an innocent man called Peyton Farquhar as his main character because he wanted us to feel sorry for him and angry with the officers for causing the pain inflicted. Farquhar took the role in the war because he had always wanted to be part of it.He was not allowed to fight for his own country so when the enemy tricked him, he was no wiser and was trying to help his side and so he did what the enemy wanted. ' I observed that the flood of last winter had lodged a great quantity of driftwood against the wooden pier at this end of the bridge. it is now dry and would burn like a tow'. In the last moments of his life we learn so much about his personality, feelings and thoughts.

Gypsies, the Work Ethic and Hungarian Socialism

In his work Socialism; Ideals, Ideologies and Local Practice, Chris Hann includes the text in which Michael Steward analyses the Gypsy responses to Hungarian social policy providing the image of the sources of popular resistance to the massive experiment in social engineering undertaken by the socialist governments of the Soviet bloc. The text focuses on the twenty five years period in which the Hungarian Socialist Workers’ Party led a vigorous campaign to assimilate the near half-million Gypsy population into the Magyar working class by trying to eliminate all traces of Gypsy lifestyle and behavior. In the author’s view there was there was an important plank formed in the social policy of the Hungarian regime. This happened due to several reasons: the largest minority in Hungary lived shocking poverty conditions, the state was looking to renew its socialist pledge by modernization under social equality and the economic, social and cultural distinctiveness of the Gypsies. The result of this campaign was not the one intended because Gypsies were in 1985 as prominent in the Hungarian society as they were in 1960. Moreover, the state had managed to create conditions in which, in popular imagination at least, being a Gypsy seemed the most viable way to survive the privations and humiliations of a planned economy. The campaign to assimilate Gypsies in socialist Hungary The campaign lasted from 1961 to 1985 and it began with the decision that Gypsies were neither an ethnic group nor a nation. Cultural factors did not play a significant role in the reproduction of Gypsies and the attempts to turn them into a nation had been misguided. Gypsy nationalists programs slowed down the process of assimilation and their self-organization and expression were to be discouraged. The author states the Gypsies were characterized by a way of life marked out behavioral traits such as scavenging, begging, hustling, dealing and laziness, all being products of their exclusion from the society and the economy of the past. Gypsies had been sustained by the feudal division of labour in which they had played an important role but lost their social importance as capitalist industrialization displayed their skills as redundant. The Hungarian social government thought in the early 1960s that â€Å"the Gypsy problem† could be solved once and for all.

Tips on Mandarin Chinese Pronunciation

One of the first steps in learning Mandarin Chinese is becoming accustomed to the languages pronunciation. Learning how to pronounce Mandarin Chinese helps with speaking and listening skills as it is a tonal language.   What Makes a Syllable? The Mandarin language has 21 consonants and 16 vowels. They can be combined together to create more than 400 mono-syllabic sounds. There are also four tones that change the meaning of the syllable, so in theory, there are about 1600 possible syllables. Only around 1000 of these are commonly used, however, which means that Mandarin words actually are more similar than words in English. Similar to English, you should learn to hear the tone differences and work on learning how to pronounce Chinese sounds. Sound Chart Here is a chart of the 37 sounds of Mandarin with a sound clip of each. Practice these as much as you can—they will provide the foundation learning how to pronounce Mandarin. The sounds are given in Pinyin, but please be aware that each letter does not represent just one sound.  Just like how in English, the vowel a is pronounced differently in different cases. For example, compare the more nasally-sounding ant to the elongated a in at. There are also  many tricky cases you need to learn  in Chinese! Pinyin Explanation Sound Clip b similar to 'b' in the English 'boat' - softened to approach a 'p' sound audio p similar to 'p' in the English 'top' - with more aspiration audio m same as 'm' in the English 'mat' audio f same as 'f' in the English 'fat' audio d similar to 'd' in the English 'down' - softened to approach a 't' sound audio t similar to 't' in the English 'top' - with more aspiration audio n similar to 'n' in the English 'name' audio l similar to 'l' in the English 'look' audio g similar to 'g' in the English 'go' - softened to approach a 'k' sound audio k similar to 'k' in the English 'kiss' - with more aspiration audio h similar to 'h' in the English 'hope' - with a slight rasp as in 'loch' audio j similar to 'j' in the English 'jeep' - tongue is positioned below lower teeth audio q similar to 'ch' in the English 'cheap' - tongue is positioned below lower teeth audio x similar to 'sh' in the English 'sheep' - tongue is positioned below lower teeth audio zh similar to 'j' in the English 'jam' audio ch similar to 'ch' in the English 'cheap' audio sh similar to 'sh' in the English 'ship' audio r similar to 'z' in the English 'azure' audio z same as 'ds' in the English 'woods' audio c similar to 'ts' in the English 'bits' audio s similar to 's' in the English 'see' audio (y)i similar to 'ee' in the English 'bee' audio (w)u similar to 'oo' in the English 'room' audio yu purse your lips and position the tongue high and forwards audio a similar to 'ah' in the English 'Ah-hah!' audio (w)o similar to 'or' in the English 'bore' audio e similar to 'er' in the English 'hers' audio (y)e similar to the English 'Yay!' audio ai similar to the English 'eye' audio ei similar to 'ei' in the English 'weigh' audio ao similar to 'au' in the English 'sauerkraut' audio ou similar to 'ou' in the English 'dough' audio an similar to 'an' in the English 'fan' audio en similar to 'un' in the English 'under' audio ang a Mandarin 'a' followed by the 'ng' sound like in the English 'sing' audio eng a Mandarin 'e' followed by the 'ng' sound like in the English 'sing' audio er a Mandarin 'e' with the tongue curled back audio

Understanding Emotional Intelligence ( Ei ) - 1943 Words

Today they define Emotional Intelligence (EI) as â€Å"the ability to identify and manage your own emotions and the emotions of others.†(Psychology Today, 2014) It is an aspect or characteristic that is essential in understanding ones emotional ability to monitor and be aware of their personal emotions as well as others, but to also be able to decipher different types of emotions and be able to apply those emotions to different types of behavior appropriately. Throughout history and research it has been proven that this skill has been tested in order to validate someone for different positions such as leadership performance or even job performance. This type of models that are used to assess EI being; ‘The Mix Methods Model’ and the†¦show more content†¦Interpersonal abilities include awareness of others’ emotions, feelings, and needs, as well as the ability to establish and maintain cooperative, constructive, and mutually satisfying relationships. (EQ-i:S, 2014). Theoretical Orientation Theoretical orientation is the guiding principle in organizing a treatment and it provides information (Kolmes, 2009). The theo ries give different understandings into all aspects of psychology such as counselling, assessing people, test development, research, and teaching. It is the theory a psychologist bases their practice and develops their research on (Kolmes, 2009). The two emotional intelligence tests, the MSCEIT and the EQ-I, have different theoretical orientations. Reasons for this are that the developers of each test would have different orientations to which they would apply to their test. Emotional intelligence is defined as the ability to monitor one’s own and other’s feelings and emotions, to discriminate among them, and to use this information to guide one’s thinking and action (Mayer Salovey, 1990). The MSCEIT ability models define EI as a form of intelligence, whereas mixed models take a widespread approach and include dispositional, motivational, and situational variables in their take on EI (MacCann, Matthews, Zeidner, Roberts, 2003). The two tests have different measurement approaches. The MSCEIT uses tests of maximalShow MoreRelatedEmotional Intelligence (Ei) Is A Topic That Has Not Been1647 Words   |  7 PagesEmotional intelligence (EI) is a topic that has not been completely explored because organisations do not see it as a current need, unless the role itself requires a measure. For this reason, it is a debated topic and still being researched. This essay will analyse the value of testing emotional intelligence during the employee selection process, its benefits and drawbacks, and the implications for the organisations to ensure testing emotional intelligence is valuable. In terms of employee selectionRead MoreThe Topic Of Emotional Intelligence ( Ei )1495 Words   |  6 PagesThe topic of emotional intelligence (EI) has been heavily debated for a number of years. There have been many theories and many different angles of research that psychologists have taken pertaining to EI, but none of that research has been overall conclusive in coming up with factual evidence of the true nature of EI. There have been many different criticisms concerning EI and it’s different methods of understanding. One psychologist says that, The first criticism is hat even if EI studies tap intoRead MoreThe Theory Of Emotional Intelligence1359 Words   |  6 Pagesway, or did they learn it along the way? Emotional Intelligence Theory attempts to answer all of these questions, and gives the rest of us a guideline on how to scale that emotional intelligence ladder. This analysis will look at the genesis of EI theory, review the applications within the school system and the workplace, and discuss how it affects to the social work practice. History Philosophers throughout the ages have hinted at emotional intelligence, but it was two American Psychologists, PeterRead MoreEmotional Intelligence : Why It Can Matter More Than Iq By Daniel Goleman1489 Words   |  6 PagesSalovey, first introduced the concept of â€Å"emotional intelligence†, or EI, in a journal article in 1990 (Goleman, 2005). It was then popularized in 1995, with the book Emotional Intelligence: Why It Can Matter More Than IQ by Daniel Goleman. Goleman posited that EI is as important, if not more important, than IQ in terms of success in academics, business, and interpersonal relationships (2005). Although the phrase was new to English vernacular, the concept of EI is not a modern idea to human philosophizingRead MoreEmotional Intelligence ( Eq ) And Emotional Quotient Essay1537 Words   |  7 PagesBobby Lindsey Mrs. Ehlers CollegeNow Comp 151 18 September 2016 Emotional Intelligence Many people ponder about the question â€Å"What is Emotional Intelligence (EI) or Emotional Quotient (EQ) and how is it different from Intelligence Quotient (IQ)?† Many people know about Intelligence Quotient or IQ and they probably hope to have a high one, but they may not realize there is also something called EQ and it plays a role in people’s lives every day. EQ is an important concept to learn and understandRead MoreUnemployment And Underemployment Of College Graduates1072 Words   |  5 Pagesand African American’s unemployment rate showed higher than White (Shierholz et al., 2014, Para 4). The report indicated that less jobs required general intelligence associated intelligence quotient (Shierholz et al., 2014, Para 4). Employers may demand a new skill set. BUSINESS AND EMOTIONAL INTELLIGENCE Importance of Emotional Intelligence Demand for teaching college students with a new skill set has increased among college educators. Learning and developing hard skills such as technical andRead MoreEmotional Intelligence : An Integral Part Of Career Success832 Words   |  4 PagesEmotional Intelligence is an integral part of career success. Our lives are the permanent competition, where leadership and success are the main goals of the majority. What is it that makes people successful? This question haunts many of us. Some people believe it is a high level of emotional intelligence (EI). In order to accept this point of view, we have to understand what EI is, how people develop it, and how EI benefits our career success. First of all, we have to determine the meaning ofRead MoreEmotional Intelligence : Can It Be Taught At Distance Learning Mba Programs?1055 Words   |  5 PagesEmotional Intelligence Students Name University Name, Course Number Emotional Intelligence: Can it be taught in Distance Learning MBA Programs? Today, managers need more than just top notch technical and intellectual skills. Leaders in healthcare, business and technology are learning that successful managers need high Emotional Quotient (EQ) or Emotional Intelligence (EI) to work effectively. This paper will define EQ and EI and then explore why these skills improve workplace functioningRead MoreThe Original International Personality Item Pool1024 Words   |  5 Pagesscale level of the IPIP-50 (Guenole Chernyshenko, 2005). Before looking at the research examining the relation between the FFM and EI, this literature review first presents some of the current findings in EI. Although intelligence has been studied for over a century, the study of emotional intelligence is relatively new in comparison. One commonly used definition of EI is ‘the ability to understand your own emotions and those of people around you’ (Maltby et al., 2010, p. 392). There are four mainRead MoreEmotional Intelligence And Human Resource Management1144 Words   |  5 PagesIn the past years, many people have written about emotional intelligence role in the workplace. Experts belong to emotional intelligence (EI) field provides many models and definitions to understand the concept and meaning of emotional intelligence and its effects on individual’s (Employees, managers, supervisors) performance. As the world is becoming organizational world and as the time passes change is occurring in almost every field. Thus Organizations (public and private sector) have to manage

The Internet Of The World - 1606 Words

â€Å" In the next century, planet earth will don an electronic skin. It will use the Internet as a scaffold to support and transmit its sensations. â€Å" - Neil Gross Introduction Connectivity is a basic human need and desire to share information and communicate. Roads connected places, telephone connected people and most recently the Internet connected people and communities around the world. The next big connection the world is going to see is the Internet of Things (ioT) which shall connect many objects which may or may not computers connected to the world. The basic aim of ioT is to make the entire world not only connected, but deeply and widely connected. It can be done if each object is addressable, accessible and actionable. The Internet of Things connects devices and machines such as everyday consumer objects and industrial or transport equipments onto the internet. There are nearly 10 exabytes of data stored over computers worldwide and all over the Internet. Most of it has been typed by human hands or taking a picture or pressing a button. But now people have limited accuracy, time and attention, which means human beings are not very good in capturing data around the world. ioT can provide devices and machines with the ability to capture data which will be more accurate than humans and also reduce load on human beings. Working Devices which are a part of ioT are expected to become active participants in business, information and social processes where they canShow MoreRelatedThe World Of The Internet1452 Words   |  6 PagesPharaoh of Egypt only has access to with sex, you can see what he saw†¦ but even weirder. There’s some weird porn out there everyone. I’m talking porn that goes to the levels of â€Å"how the hell can anyone get off on that. Well, welcome to the world of the internet where Rule 34 exists. What is Rule 34? Well, it basically states that if something exists, a porn exists for it — no exceptions. When it says no exceptions, it means no exceptions. Now, I begin going into the weird porn, just weird porn willRead MoreThe Internet And Its Effects On The World941 Words   |  4 PagesEver since the internet was established it has become a never ending source of information spread worldwide. Now it has become a huge entity for communication and spreading of information across the world. With great promise also brings greats faults. While the internet has many useful and amazing abilities it is also exploited for uses that are illegal and cruel. People use the internet to steal other people’s work, buy and sell drugs, and upload and watch child pornography. The only way toRead MoreA World Without Internet?1201 Words   |  5 PagesA world without internet? One day, many years ago, a brilliant man by the name of Tim Berners-Lee created an extraordinary thing, something that was to revolutionize the entire human race and its existence. It was an idea so great that it would have been seen as insanity not many years before its own creation. We call it â€Å"The World Wide Web.† A gigantic spider web of servers spread out all over the world, hosting websites with information that would else only be found in the form of books. It worksRead MoreCisco : The World Of The Internet1604 Words   |  7 Pagesthe top 5 companies in Return on Revenues as well as Return on Assets (Nolan, Porter, Akers, 2005). In the early days, Cisco began with routers; connecting computers to the world of the internet. The internet made it possible to connect all 3 of their proprietary networks: Data, Voice and Video. By 1999 more than 75% of internet traffic traveled over Cisco products. Financially, Cisco was extremely successful and after 14 years in business, Cisco’s capitalization passed the $100 billion mark. WithinRead MoreThe World Without The Internet888 Words   |  4 PagesIn today’s technology driven world, it’s almost impossible to imagine the world without the Internet and its numerous benefits. It has become the platform for almost every field imaginable like business education, entertainment, communication, etc. The internet is everything Past, Present and Future.1 It has empowered us to exchange data, opinions and news across the continents. As per internetlivestats, there are approximately 3,207,910,219 internet users across the globe which is almost 45% ofRead MoreThe World Of Technology And The Internet Essay1246 Words   |  5 Pages In the world of technology, the internet has transformed the way we go about our daily lives. Forty years ago, only a few thousand people had access to the internet. Today, the internet is a tool that mostly everyone has access to. With the invention of cell phones, we have the internet at the tip of our fingers. The internet is continuously getting faster and smarter with the help of better developing technology. The internet use to only be used to learn how to build and use networks. With theRead MoreThe Internet And Its Effects On The World997 Words   |  4 PagesOver the years the internet has been more and more easier to access. The internet has grown exponentially and people all over the world are taking advantage of it day by day. The ones that are getting the most benefit out of it are students. Doing assignment has never been easier, for example, Google can help out finding research informatio n that was hard to find in school textbooks. The internet not only gives the student updated information on the certain topic, but it also as well saves them aRead MoreCisco : The World Of The Internet1559 Words   |  7 Pagesranked in the top 5 companies in Return on Revenues as well as Return on Assets (Nolan, Porter, Akers, 2005). Originally, Cisco began with routers; connecting computers to the world of the internet. The internet made it possible to connect all 3 of their proprietary networks: Data, Voice and Video. By ’99 more than 75% of internet traffic traveled over Cisco products. Fiscally, Cisco was extremely successful. After 14 years in business, Cisco’s capitalization passed the $100 billion mark. Within theRead MoreThe Internet And Its Effects On The World1716 Words   |  7 PagesWith broad information outputs, the internet has widely shaped the world we live in today. From being a source that can aid one with education such as homework or a tool to be tutored online, to helping one do last minute online holiday shopping if one procrastinated and is now in a rush to find gifts for one’s family. Therefore, the question ponders when does one draw the line on the magnificently powerful tool we call â€Å"the internet† as it stops aiding one and starts becoming harmful to one mentallyRead MoreThe Internet And Its Impact On The World Essay1488 Words   |  6 PagesThe internet is defined as system of interdependent networks that utilize the internet protocol to connect multiple computers globally (Eblner, 2009, p. 333). It has gradually changed the manner in which information is relayed and people connect. Its vast effect is perhaps seen in the way companies market themselves – making it easier than any other time before to directly engage with customers – and socializing or networking with friends, families, and associates through social media. The internet

Nursing Standard

Question: Describe about the Article for Nursing Standard? Answer: Case of Oscar a) Asthma is characterized by the inflammation of the bronchospasm and airways. This causes the contraction of the bronchioles due to airway reactivity. The pathophysiology involves inflammatory response and the activity of the allergic response cells is triggered which includes the T-lymphocytes, B-lymphocytes, eosinophils, neutrophils, mast cells, etc. It also includes the chemical mediators often secreted by the lining of cells of the respiratory tract, which collectively causes the inflammation. But the key impact is the increased secretions and swelling of the airways. These reduce the airway diameter and consequently the air entry. In the case of an acute asthma attack, bronchospasm accompanies the inflammation (Redwood and Neill 2013). b) Inhaled corticosteroids (ICS) are the most useful and important medicines in asthma management. They are the most commonly used medicine as the preventer and is used globally. They are very effective and safe for long-term usage. The type of steroids used in these inhalers is artificial cortisol, which is a steroid. This reduces the symptoms of asthma by reducing the inflammation in the airways. There are a number of side effects as it is common with the higher dosage of steroids. These have been listed below. Local irritation in the throat and mouth. Osteoporosis Bone thinning. Skin thinning. Reduction in response to illness. Minor growth suppression. ICS can be used for a lifetime by minimizing or avoiding the side effects. This can be done by using spacers and medications for prevention and cleaning and rinsing the teeth and mouth after using the medications. ICS can be taken daily with visible results within 1 to 3 weeks and best results within three months. c) Short-acting beta agonists (SABA) act by dilating the airway lining and muscle relaxation thereby facilitating air passage to the lungs. They act as bronchodilators. As the airflow is increased, the breathing gets easier. The onset of action is within five minutes and the duration of action is three to six hours. However, they do not have any impact on inflammation. SABA are the best choice of treatment in case of asthma attack and treating the intermittent symptoms. Some of the common SABA are Salbutamol, Levalbuterol, Metaproterenol and Terbutaline. They help with the symptoms of chest tightness, wheezing, shortness of breath and cough (Carr 2013). Most of the medications have the tendency to produce side effects. In case of any side effect, the pharmacist should be contacted. The most common side effects have been listed below. Skin rash and hives. Palpitations and increased heartbeats. Dizziness and headache. Diarrhea, vomiting and nausea. Tremor and nervousness. Since SABA has a short onset of action, people tend to overuse these medicines instead of the long term and slower acting ones. However, the overuse may lead to reduction in the future effectiveness. Therefore, they should not be taken daily and should be taken only in case of symptoms. In addition, the dosage needs to be maintained. Case of David a) The diagnosis of asthma involves the signs and symptoms recognition. Airflow obstruction measurement and initial assessment can be followed. Diagnostic tests can suggest that the patient has asthma. Diagnostic symptoms like a heavy cough and tight chest on exertion make the chances of asthma more likely. Since David had a cold two months ago, his chest tightness should have been cured by now. In addition, his cough is worsened at night, which increases the probability of asthma. David does not have a history of asthma. So his present symptoms clearly indicate towards the fact that he needs diagnostic confirmations by objective measurements. b) Spirometry has been recognized as the first line diagnostic test for patients with suspected asthma. Since David has been diagnosed with the symptoms of asthma, so spirometry test has to be performed for reproducible and accurate results of airway obstruction. Methacholine challenge test is another diagnostic test that can be performed on David if the spirometry results are not satisfactory. Methacholine, when inhaled, contracts the airways and causes spasm in case of presence of asthma (Thomas 2015). c) Spirometry is a pulmonary function test which measures the lung function which includes the flow and volume of air that is exhaled and inhaled. Spirometry is an important tool for the diagnosis of asthma. The process involves forced inhalation followed by forced expiration on the sensors for a minimum duration of six seconds. A rapid inhalation follows during the diagnosis of the obstruction of the upper airways. The test is sometimes preceded by the measurement of the tidal volume. Filter mouthpieces prevent the contamination by microorganisms and nose clips are used to prevent the escape of air from the nose. Height and weight have to be measured prior to the beginning of the test (Madsen et al. 2014). The advantages of spirometry have been listed below. Spirometry is an and readily available process. It is a useful tool for the monitoring and diagnosis of asthma. Spirometry is a time-saving process and is performed quickly. The spirometer device is portable and cheap, so most of the clinics and patients can afford it. The disadvantages of spirometry have been listed below. This is an effort dependant process. Any variations in the effort give variable results. It has poor compliance with the patients with asthma as they have to inhale and exhale in full volume, especially in case of asthma and chest tightness. Sometimes false readings are derived which are often high due to patient manipulations. There is a high probability of result manipulation due to the patient efforts and leakages. Case of Aisha a) For asthmatic patients, treatment with metered dose inhalers is the foundation of the therapy. However, the full value of the medications is not often obtained, as the inhaler is not used correctly. Suboptimal results are common in such cases. Some of the common errors associated with the using of MDI have been listed below. Insufficient shaking of the inhaler. Gentle exhalation prior to inhaling the medication. Poor coordination between the pressing of the canister and inhaling it simultaneously. Poor inhalation amount or no inhalation at all. Insufficient duration of holding the breath or not holding it at all (10 seconds is desirable). No sufficient gap between two puffs (30 seconds is desirable). Multiple pressing of the canister. No periodic cleaning of the actuator. Wrong holding of the device without placing the mouthpiece on the bottom side. No removal of the cap before pressing down the canister (Price et al. 2013). b) While selecting an inhaler device, the type of drug delivered has to be kept under consideration. The choice of drugs decides the type of inhaler to be employed. This drug-inhaler relation has been described below. Bronchodilators and corticosteroids are delivered by pMDI (Pressurized Metered Dose Inhaler) with spacers and facemask. For children aged 3-5 years, nebulizer may be used in case a pMDI have been found to be ineffective or a dry powder inhaler (DPI) may be used. Cost reduction or economic factors also determine the type of inhaler to be used. Since Aisha complains of her MDI being ineffective, alternatively nebulizer or dry powder inhaler may be used (Asthma inhalers 2015). c) Metered dose inhalers are the reliever medicine or rescue inhalers. These are autohalers that are generally breath actuated and also nonbreath actuated. Dry powder inhalers require the medication in the form of fine powder. These can be classified as devices of single dose, multi-dose and unit multiple doses. These are breath actuated and are very popular among the children. They are all either corticosteroids or bronchodilators. The differences between the MDI and DPI have been listed below. Feature MDI DPI Inspiratory flow rate 30 L/min 30-120 L/min Patient effort By pressing the top of the medication canister, simultaneous inhalation has to be done by mouth unless the lungs are filled completely. The medication has to be held inside for the maximum possible duration and then exhale. The procedure has to be repeated if required after a gap of one minute. A spacer may also be used to facilitate the process. The patient effort is different for different devices. However, the general patient effort for single use devices involves the loading of the capsule as per the provided directions. This is followed by exhalation completely and slowly. The lips have to be sealed which is present surrounding the mouthpiece. Inhalation by mouth has to be done deeply and quickly for approximately three seconds. Hold the inhaled breath for the maximum possible duration and exhale slowly. Table 1: The differences between the MDI and DPI Source: By author d) The selected device for Aisha would be Dry Powder Inhalers. DPIs do not employ the propellants as they have been found to damage the ozone. They rule out the need for the simultaneous act of squeezing the canister and inhaling, which makes the process quite simple for the children. Aisha should be well advised that she should not exhale forcefully in the device prior to inhalation as it may result in the scattering of the powdered medication. Case of Colin a) Since Colin has a confirmed diagnosis of asthma, he is in a condition of acute asthma, which requires intense treatment for preventing it from getting into the state of uncontrolled. The treatment involves high dose of inhaled and systemic corticosteroids. The categories of severity in acute asthma are mild or moderate, severe and life-threatening. The final stages of acute asthma may require mechanical ventilation. Increased inflation pressure may be accompanied. The assessment of severity of acute asthma can be done on the basis of clinical observations and the measurement of pulse oximetry while breathing. A bronchodilator has to be administered immediately (Rodrigo and Neffen 2015). PEF and blood gases have to be measured for the complete assessment. Chest X-ray and systolic paradox are the secondary assessment tests for acute asthma (Arnold et al. 2012). b) Measurement of PEF or Peak Expiratory Flow is the most important clinical assessment of acute severe asthma. The PEF value of 50% marks the presence of acute severe asthma and 33% marks the presence of life-threatening asthma. The initial management involves immediate treatment in an area of resuscitation and high dependency. The SaO2, ECG and blood pressure has to be monitored. The patient has to be kept calm as fear can worsen the respiratory distress. Hypoxaemia is inevitable in the patients with severe acute asthma. So oxygen administration in high inspired concentration is essential to maintain the SaO2 92%. Nebulizers, which are oxygen driven, should be employed to prevent hypercapnoea. In case severe acute asthma, hypercapnoea may lead to the life-threatening situation. Salbutamol or Terbutaline along with Ipratropium bromide have to be administered through a nebulizer. Prednisolone or hydrocortisone tablets may be administered as per the condition of the patient. A chest X-ray may be beneficial to assess the severity of the attack (Lalloo et al. 2013). c) The secondary management of asthma attack will determine whether Colin has to be administered to the hospital. If Colin is improving after the initial management, he may be continued with oxygen for the maintenance of SpO2 of 94-98%, Prednisolone or hydrocortisone at the required dosage and Ipratropium along with 2 agonist in the nebulized form and released. If Colin is not improving even after 30 minutes of the initial management, the steroids and oxygen have to be continued, nebulized Salbutamol after every 30 minutes and continued ipratropium 4-6 hourly until he improves. If the condition of Colin does not improve even after the subsequent and secondary management, he has to be administered to the hospital and continuous monitoring has to be done. d) Following the hospital discharge, Colin should be advised to follow up within two weeks. However if emergency conditions arise, he needs to follow up at the earliest. The assessment of the history of Colin would reveal the possible reasons for the exacerbation of asthma and precautions to be taken to counter the future emergencies. Medications have to be reviewed as per the requirements of Colin and an action plan has to be provided to prevent assistance delay, prevent relapse and for optimizing treatment (Rowe 2014). References "Asthma inhalers", 2015,Nursing standard (Royal College of Nursing (Great Britain): 1987),vol. 29, no. 24, pp. 19; discussion 19-19. Arnold, D.H., Gebretsadik, T., Abramo, T.J., Sheller, J.R., Resha, D.J. and Hartert, T.V., 2012. 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