Free Essays on Play Therapy

Play Therapy Both directive and non directive Art Therapy Parenting skills Filial Play Therapy Modeling to the parents as a secure base for Juan Play therapy Coping skills Supportive â€Å"Play therapy is a helping interaction between a trained adult and a child that seeks to relieve the child’s emotional distress through the symbolic communication of play (Webb, 1999, p.30).† Through the interpersonal interactions with the therapist, the child experiences acceptance, catharsis, reduction of troublesome affects, redirection of impulses, and a corrective emotional experience. It is the therapist’s interventions and utilizations of the play that are critical The primary purpose of play therapy is to help troubled children express their conflicts and anxieties through the medium of play in the context of a therapeutic relationship. Play therapy helps establish the treatment relationship, provides a medium for working through defenses and handling anxieties, assists in the verbalization of feelings and helps the child to act out unconscious material and relieve the accompanying tensions (p.32)\ Directive and Nondirective Therapist-directed play therapy – Specific skills are being taught and/or emphasized such a sproblem-solving. Therapist chooses the toys, how they will be used, and for what length of time. Filial Therapy A major purpose of filial therapy is to strengthen parent-child relationships. Helps families to learn healthy interaction patterns and parenting skills that they can use as their relationships develop throughout their lives. It serves a preventive function by empowering families to strengthen themselves. VanFleet 1983, p.373 Art Therapy Cognitive-Behavioral Approaches with a focus on positive thinking and active problem solving. Weight problem TV watching Physical Activities Special time with mom Going to school Parental Involvement Parent education Sett... Free Essays on Play Therapy Free Essays on Play Therapy Play Therapy Both directive and non directive Art Therapy Parenting skills Filial Play Therapy Modeling to the parents as a secure base for Juan Play therapy Coping skills Supportive â€Å"Play therapy is a helping interaction between a trained adult and a child that seeks to relieve the child’s emotional distress through the symbolic communication of play (Webb, 1999, p.30).† Through the interpersonal interactions with the therapist, the child experiences acceptance, catharsis, reduction of troublesome affects, redirection of impulses, and a corrective emotional experience. It is the therapist’s interventions and utilizations of the play that are critical The primary purpose of play therapy is to help troubled children express their conflicts and anxieties through the medium of play in the context of a therapeutic relationship. Play therapy helps establish the treatment relationship, provides a medium for working through defenses and handling anxieties, assists in the verbalization of feelings and helps the child to act out unconscious material and relieve the accompanying tensions (p.32)\ Directive and Nondirective Therapist-directed play therapy – Specific skills are being taught and/or emphasized such a sproblem-solving. Therapist chooses the toys, how they will be used, and for what length of time. Filial Therapy A major purpose of filial therapy is to strengthen parent-child relationships. Helps families to learn healthy interaction patterns and parenting skills that they can use as their relationships develop throughout their lives. It serves a preventive function by empowering families to strengthen themselves. VanFleet 1983, p.373 Art Therapy Cognitive-Behavioral Approaches with a focus on positive thinking and active problem solving. Weight problem TV watching Physical Activities Special time with mom Going to school Parental Involvement Parent education Sett...

Make an analysis of the property development environment (Residential) Assignment

Make an analysis of the property development environment (Residential) focusing on a regional property sector of (Nottingham) - Assignment Example It has created a demand for the vehicular traffic to move at slower speeds, which also includes the car owners. The need for a slow vehicular traffic in regards to the creation of housing estates signifies the importance given to social activities. People living in the small towns desire to create a community for them where they can have open space to carry on socializing and community activities. In turn, the housing estates thus created along small towns and cities would be free from communal harms like thefts and robbery. Further, it also targets to reduction in the rate of accidents owing to vehicular traffic and creates a safer roaming environment for the children living in the estates. (Clayden, McKoy & Wild, 2006, p.55). In regards to the above context, the paper focuses on the needs for development of residential property development focusing on the area of Nottingham. It analyses the features built in the residential projects citing their relevance to residential comfort. In that a case study of the Nottingham residential projects is done. Factors, which trigger the development of the modern residential areas, have also been dealt with to give a brief understanding of needs development. Finally, the future development of the residential projects is underlined to trace its growth in the coming period. The aim of the research is to analyze the development in regards to residential property segment focusing on the Nottingham area. It aims to understand the causes, which led to the need for developing the housing property. It focuses on the areas where development was initiated, analyzes its efficacy in regards to the residents’ comfort levels. The increase in the residential space in the United Kingdom is referred to as the increase in the ‘Home Zones’. ‘Home Zones’ signify the concept of shared spaces. It means that both vehicles and civilians would share the streets

Week 6 Case Study 2 Submission Assignment Example | Topics and Well Written Essays - 500 words

Week 6 Case Study 2 Submission - Assignment Example A PKI is a foundation where it acts as an overall security whereby all the other components and features must work. This paper will not look into the underlying structure of cryptography. PKI is a very wide cryptographic technique. This paper will offer the real opportunities that can be adopted, by the Software Company, to remove their fears, and misconceptions on the use of this technology. In addition to this, paper will also look into the rationale as to why this technology is suitable for various business applications. There are components which are available in a PKI framework. These components include operational policies, security services, and interoperability protocols which are all geared to support the use of public-key cryptography. The generation and management of public keys occurs through the use of Certificate Authorities (CAs), Registration Authorities (RAs) and directory services which can be used to establish a list of trust. At the national level, the use of PKI can be very instrumental when dealing with security. One of the principles of PKI is to establish a trust hierarchy (U.S General Services Administration Government Smart Card handbook, 2004). In e-commerce, when dealing with trust mechanisms, there must be the provision of management control. There must be a management control at the Ministry of Information. In the e-commerce environment, entities, which are not known to each other, do not have enough trust that has been established to perform business, contractual, legal, or other types of transactions. For this trust to be achieved, the implementation of PKI should be done by using CA. In summary, the working of CA is as follows. For entities which are unknown to each other, they will each establish a trust relationship with a CA. The CA will perform some form of entity authentication according to the rules that have been established as has been noted by the

Toxicology Research Paper Example | Topics and Well Written Essays - 250 words - 1

Toxicology - Research Paper Example Furthermore, epidemiologic studies have established that cigarette smoking seriously aggravates the symptoms of asbestosis and increases the risk of cancer. However, the synergistic interaction between tobacco smoking and inhalation of asbestos remains yet to be established and is subject to hypothesis. Asbestos as well as tobacco smoke is a well-established lung carcinogen. It is known that inhaled asbestos fibers remain in the lungs for years eventually assisting in the formation of free radicals and reactive oxygen species that subsequently cause excessive scarring, tissue injury, and cellular growth in the lungs via large scale loss of chromosomes. Although several hypothesis has been put forward to explain the multiplicative effects of asbestos and tobacco smoke, it is possible that asbestos fibers on the lungs surface concentrate the tobacco carcinogens thereby enhancing delivery of the large amounts of carcinogens to the nucleus of the target cell. Indeed, this hypothesis is s upported by a modeling experiment in which it was shown that phospholipids coating the lung epithelium adhere to the asbestos fibers, which ultimately enhance the hydrophobicity of the fiber (Gerde & Scholander, 1988).

Assignment 2 †Why Teaching Essay Example for Free

Assignment 2 – Why Teaching Essay It is important not only for you, but for your Field Supervisor and me, to know what led you to enter the teaching profession. For this assignment you are to write a 300-500 word essay on Why I Elected to Travel the Road to Teaching. ***The first part of your paper will explain your life experiences which led you to pursue a career in teaching. ***The second part of your paper will name/identify the 3 main keys to success as identified in Keys to Success for New Teachers. ***The third part of this paper will explain how the knowledge of these keys can help you be a successful teacher? (You will probably need to review these keys found in the course material. ) Formal writing is required. Your paper must incorporate correct sentence structure, punctuation, capitalization and grammar. EDTC 5100 – Assignment 2 Name: Cameron Guidry Last 4 digits of SSN#: 2381 1. Why I Elected to Travel the Road to Teaching My road to becoming a teacher is perhaps less romantic than some would like. I didn’t enjoy school when I was younger and felt no inclination to be a teacher. I did, however, find a passion for learning and writing when I was earning my undergraduate degree at The University of Kansas. Meeting instructors who were excited about their subjects got me excited too, and eventually I was getting excited all on my own. The experience was entirely foreign to me. I was reading just to read and writing without being told. I had spent my four years of high school counting the hours until it was time to leave, and it was the realization that this didn’t have to be the high school experience that pushed me toward teaching as a career. I still have a passion for the subject, and I am currently earning a PhD in English, an endeavor that is entirely fueled by my own passion. It is my hope, and experience up to this point, that I can inject that enthusiasm into my classroom. I spent two years teaching at the university level, and found success. It was as I had imagined; I had students who entered my room uninterested and left my room well equipped readers. The issue I saw was that I would only have the opportunity to interact with those fortunate few that made it to my college classroom, and it was my desire to offer what I could to a more diverse group, perhaps illuminating a possibility that wouldn’t be clear without my presence. I don’t expect to create a graduating class of English majors, but I do believe that I can provide the role model that my students can benefit from. I feel an obligation, one that I created myself, to educate. It’s not an obligation I fulfill begrudgingly; it is one that I happily attempt to answer and is my road to teaching. 2. Name the Three Keys They are be reasonable, organize your life, and reflect. 3. Tell how the keys can help you to be a successful teacher? These three keys are helpful for life in general, but as a teacher I am finding myself constantly on my back foot while answering questions and asking someone to take their seat. It can be overwhelming, but by finding my center outside of the classroom, and achieving some understanding before the bell rings, attempting to control the chaos becomes a managable thing. Additional Comments:

Medicaid for Millionaires :: essays research papers

Summary: Medicaid for Millionaires briefly touches on one of the many problems facing the U.S. and its current Medicaid policy. The articles begins by acknowledging the fact that Medicaid was originally formed in 1965 with the intent of providing medical care just for the poor, and how lately this hasn’t been the case. Today were finding out how more of societies upper-class are discovering ways to receive Medicaid benefits as well. The system is being called â€Å"Asset-Shifting†, were anyone is allowed to give away most of their assets (no matter the cost) to someone else and three years later claim the same medical benefits being set aside for the poor. As quoted in the article â€Å"there’s an entire industry being dedicated to making sure that other taxpayers, not they, be responsible for paying the nursing-home needs of the richâ€Å". Though morally questionable, more and more Medical Planners today directly counsel their well-off clients on how to take advantage of this loop-hole in our system. A more troubling fact is that of the 100% of the less fortunate that occupy the scarcer Medicaid beds being provided by the government, 70% of those in well kept nursing homes receive the same exact Medicaid benefits. Many government officials have tried to stop this on going trend by passing laws during the 90’s that required states to recover the cost of benefits from the estates of those who attempt asset shifting, however failing miserably due to half-hearted efforts.   Ã‚  Ã‚  Ã‚  Ã‚  To our governments credit the efforts of a decade ago didn’t break sprits of our lawmakers who still feel that asset shifting is a unjust practice. Four states have already implemented the new Partnership Program, which allows a consumer who buys, 100,000 in long term care to exempt that sum before claiming the rest of their assets, which would in turn allow that person to preserve money for their heirs and/or purchase the long-term care of their choice.

Pathology and Contemporary Treatment Alternatives

According to the Centers for Disease Control and Prevention, asthma is a complex disease on the rise in the United States. Most at risk include poor or inner city minorities that present with inordinately high rates of mortality resulting from the condition (CDC, 2005). Asthma may also be on the rise due to environmental factors including increased pollution and exposure to environmental toxins that may affect lung capacity (CDC, 2005; Hwang et. al, 2005; Yang, et. al, 1997; Wickman, et. al, 2003). Asthma is a serious, potentially life threatening condition for the millions of sufferers worldwide. Doctors are still working to determine the cause of this disease and finding new ways to treat it. While there is no cure for asthma yet, researchers have uncovered multiple treatment alternatives that help patients with asthma effectively control their condition. Education, public response and intervention are all critical success factors for predicting the quality of life for patients with asthma now and in the future. Research supports the use of a defined set of treatment protocols for assisting patients with asthma lead a better quality of life. The basis for treatment, anatomy and physiology of the respiratory tract and pathology of asthma in patients are all discussed in greater detail below. Normal Lung Function and Respiratory System The human body has two lungs located on either side of the chest. The lungs functions include passing oxygen from outside the body into our bloodstream and releasing waste materials in the form of carbon dioxide back into the environment (Gershwin & Klingelhofer, 1992). During each breath the body inhales oxygen and exhales carbon dioxide (Polk, 18). Oxygen combines with carbohydrates and fat in the body to product energy. During the process of creating energy water and carbon dioxide are formed that are expelled through breathing. The lungs consist of several anatomical structures including the bronchial tubes that enable expansion and constriction of the muscles in the lungs and chest. These tubes consist of muscles that allow air to pass deep in to the lungs. Bronchial tubes consistently change width, increasing in girth as an individual inhales and becoming narrower upon exhalation. In a person with a well functioning respiratory system all parts of the airway function synergistically to ensure maximum intake of oxygen and exhalation of carbon dioxide with each breath. Air enters the body through the nose and mouth. It passes through the pharynx, larynx and trachea, all important parts of the airway (Polk, 18). The noses and sinuses act as conditioners adjusting the air temperature as it passes through other structures in the airway. The pharynx or back of the throat allows liquids and solids entering the airway to â€Å"drop out before entering the lungs† (Polk, 19). Likewise the larynx helps prevent other unwanted particles in the air from entering the lungs (Polk, 19). It is here that the body's cough reflex lies. If something unwanted is present in the air being inhaled, the larynx will stimulate a cough reflex to help expel the object. While the larynx isn't the only trigger for a cough reflect it is very important to the entire breathing process (Polk, 19). When a person inhales, the chest muscles in the body contract allowing the ribs to separate slightly. Air is then drawn into the lungs. The opposite happens when an individual exhales, allowing air to forcefully come out of the lungs. The abdomen is also involved in breathing. The abdomen attaches to the front and back of the ribs, pushing them up and out when breathing. Breathing thus incorporates the chest and abdomen. The more a person engages all the muscles and organs involved in respiration including the abdomen, the better able they are to take a full breath of air. In times of old doctors ascribed asthma to anyone having difficulty breathing regardless of the cause; during the 20th century however researchers refined asthma to include difficult breathing â€Å"Because of a problem that begins in the bronchial tubes of the lungs† (Polk, 15). Asthma is a complex disorder that doctors are still working to fully understand. While doctors have uncovered many potential causes for asthma, they are still not certain what exactly causes it and how to prevent it 100 percent in all patients. In patients with asthma, the ability of the bronchial tubes to adjust their width is often diminished, resulting in difficulty breathing. Children are often at increased risk for developing asthma, as their bronchial tubes are narrower to begin with than adult tubes, thus less change in width is evident even in healthy lungs. Exercise induced asthma is a form of asthma that results when the air present in the nose and sinuses isn't prepared appropriately to pass through other parts of the airway (Polk, 19). Normally this form of asthma is easier to treat than severe forms of asthma whose cause is unknown (Hogshead, 1989; Guyton, 1991). During a bronchospasm attach involuntary spasms may prevent lung tissue from expanding to their normal size. Air can become trapped in the lungs. Cellular and structural changes often occur within the airway and lungs of patients with asthma, including thickening of the airway wall and inflammation (Saetta & Turato, 2001). Normally as air passes through the lungs the bronchiols or airways get smaller. In a patient with uncontrolled asthma however, the sides of the airways typically become enlarged or inflamed (CDC, 2005). During an acute attack, the muscles or bronchiols surrounding the airways constrict, thus reducing the amount of air a person can pass in and out of their lungs (CDC, 2005). Once this constriction begins, mucus starts forming in the airways, causing even greater constriction and distress. Typical symptoms associated with an asthma attack include wheezing, chest pain and tightness, coughing and difficulty breathing (CDC, 2005). No one is immune from asthma. Children, adults and the elderly are all at risk. Some people are more at risk than others including people who smoke, those with seasonal allergies and anyone with recurring acute respiratory infections (CDC, 2005). Signs of asthma include physical qualities of the disease a patient, family member or doctor can easily identify such as dyspnea (trouble breathing) (Polk, 7). Symptoms include complaints generally associated with the condition, and may include headaches or chest pain, skin flushing and itching (Polk, 8). Dyspnea results from multiple conditions other than asthma including infections, allergies, foreign bodies present in the airway and associated factors (Polk, 8). It is important a clinician differentiate between asthma and other causes of the disease. Basis Contemporary Treatments For Managing Asthma The National Asthma Education and Prevention Panel consistently work with doctors to develop contemporary treatments to manage asthma (Moonie, et. al, 2005). Many of these treatments are based on empirical research that supports reduction of patients symptoms and prevention of chronic attacks. The goal of contemporary asthma care and treatment includes â€Å"control of asthma and good quality of life for asthmatic patients† (Gaga, et. al, 80). The basis for much of contemporary care is empirical based research, though trends are changing in an attempt to encourage doctors to improve patient awareness and education. Many asthma drugs historically are administered through inhalation. Inhalers are often prescribed â€Å"on an empirical basis rather than on evidence based awareness: (Virchow, 24). Much of the asthma management guidelines currently available offer â€Å"non-specific advice regarding inhaler choice† (Virchow, 24). As such it is important that GP work with patients to decide what the ideal inhaler is for all patients involved. The ideal inhaler according to Virchow (2005) is one that (1) is breath activated, â€Å"releasing medication only when all prerequisites for successful inhalation are met, (2) has a low intrinsic airflow resistance so children and elderly patients may use it and (3) is one that provides a flow-independent deposition of drugs in the lungs as well as feedback that reassures patients whether the drugs has been inhaled properly (24). Newman (2005) suggests the pressured metered-doze inhaler or pMDI delivers asthma medications in a reliable â€Å"multi-dose presentation† (1177). Key components of this devices help determine the amount of drug delivered to the patient. The researcher further suggests that pMDIs can be developed that are breath actuated and coordinated with â€Å"spray-velocity modifiers† to help patients unable to use â€Å"conventional press and breathe pMDI's correctly† (Newman, 1177). Modern or contemporary pMDI's according to Newman should also contain non-ozone depleting propellants, a sentiment confirmed by Virchow (2005) as well. Patients with severe refractory asthma require more comprehensive treatment. High-doses of inhaled corticosteroids are often insufficient for treating this form of asthma. Most require contemporary treatments including oral corticosteroid administration and use of immunosuppressants (Sano, Adachi, Kiuchi & Miyamoto, 2005). Chronic use of these drugs however present a high risk for adverse side effects. A study conducted by Sano, et. al (2005) suggests that nebulized sodium cromoglycate â€Å"is expected to be a new second-line therapeutic option in severe asthma† (1). Gaga, et. al (2005) suggests that many doctors are not achieving good quality of life and control of asthma for patients. Their study of treatment outcomes for asthmatic patients in specialized care suggests that contemporary treatments should include more patient education combined with increased use of LABAs (Long-acting beta2-agonists) and leukotriene antagonists to help prevent bronchoconstriction and improve quality of life for patients. Despite multiple contemporary treatment choices, managing acute severe asthma attacks still present a tremendous health challenge to health care professionals (Barnard, 2005). Contemporary guidelines for treating acute emergency attacks currently include treatment with oxygen and inhaled beta 2 agonists, which can be administered continuously to help preserve life in acute patients (Barnard, 532). Patients discharged after such treatment should also engage in review of current medications and consider â€Å"a short course of oral steroids, a written asthma action plan and detailed advice about deterioration that may occur within 48 hours† (Barnard, 533). Butz et. al, (2005) are among a growing body of contemporary researchers that suggests that self management and patient education are critical success factors for treating patients with asthma in modern society. Their studies suggested home based educational programs that focus on accurate symptom identification and demonstration of â€Å"asthma medication delivery services† may improve patient quality of life and assist children with asthma and asthma like conditions (Butz, et. al, 190). Delaronde, Peruccio & Bauer (2005) find that â€Å"individualized telephonic case management† from registered nurses specifically trained in contemporary asthma treatment may improve asthma medication use and subsequent quality of life for patients with asthma (361). This research correlates with a growing body of evidence supporting patient education and direct support as practical contemporary treatment practices. The basis for much of contemporary treatment lies in the gold standards or clinical practice guidelines outlined by the National Asthma Education and Prevention Program's Expert Panel (CDC, 2005). These standards offer patients and health care practitioners specific guidelines for recognizing, diagnosis, treating and providing ongoing care to asthmatic patients. Because asthma is a difficult disease to diagnose, clinicians should utilize multiple diagnostic tools to determine whether airflow obstruction in patients results from asthma or other underlying conditions. Doctors should also acquire a comprehensive medical and family history and attempt to quantify the severity of a person's condition (CDC, 2005). Other contemporary diagnostic criteria helpful for assessing a patients condition include lung function tests (also referred to as spirometry) (CDC, 2005). Because there is no cure for asthma at this time doctors must work to improve the quality of life for patients presenting with asthma as effectively treat acute attacks. Doctors also work with patients to prevent attacks and recurrent episodes. Not one treatment modality works for all people because every case of asthma is unique. Because of this doctors often use various medications including injections, oral medications, vapors and inhalers. Use of inhalers to expand airflow is currently one of the most common and effective long-term treatment choices for patients with asthma. Contemporary long lasting medical treatments should include use of corticosteroids to help reduce inflammation in the lungs and airways. Most patients will inhale these medicines or take them orally. Long acting beta2-agonists are also identified as effective long-term treatments for patients with asthma. While inhalers, nebulizers and other medications all serve the asthmatic population, education should also form the foundation for modern treatment practices. Multiple researchers have concluded that patient education is effective for improving the quality of life in patients with asthma. Education also ensures that patients understand how to use their medications and do use them to prevent acute attacks. Education may be particularly beneficial for children by helping them adopt healthy behaviors early on that can help control their condition. Asthma is a complex disease involving structural and physiological components. Patients with asthma face a life long and often debilitating condition that under severe circumstances may result in increased morbidity. Fortunately there are many treatments currently available that effectively manage this condition. Contemporary management and treatment of asthma is based on empirical research that suggests multiple forms of medication for preventing and treating acute asthma attacks. The most common forms of treatment include corticosteroid administration through inhalers or oral forms. There are other equally effective medical treatments however that may work well for patients depending on the severity of their illness. No two patients are alike with respect to the condition thus treatment must be tailored to the individual. New research suggests that doctors and patients focus on prevention and education to help improve patients quality of life and experience of their disease (West, 1990). Education that starts early, as when patients are children, is likely to be more effective than education that starts years after an individual has attempted to manage their disease using other methods. Adequate evidence suggests that the manner of delivery for education does not impact a patients success rate. Thus information may be distributed in person, in the home or even over the telephone if necessary. The currently body of literature available suggest that education in the classroom may also be an important avenue for teaching prevention and treatment in the future (West, 1990). It is important that researchers and doctors continue exploring new avenues for treating and preventing this insidious disease. Pathology and Contemporary Treatment Alternatives According to the Centers for Disease Control and Prevention, asthma is a complex disease on the rise in the United States. Most at risk include poor or inner city minorities that present with inordinately high rates of mortality resulting from the condition (CDC, 2005). Asthma may also be on the rise due to environmental factors including increased pollution and exposure to environmental toxins that may affect lung capacity (CDC, 2005; Hwang et. al, 2005; Yang, et. al, 1997; Wickman, et. al, 2003). Asthma is a serious, potentially life threatening condition for the millions of sufferers worldwide. Doctors are still working to determine the cause of this disease and finding new ways to treat it. While there is no cure for asthma yet, researchers have uncovered multiple treatment alternatives that help patients with asthma effectively control their condition. Education, public response and intervention are all critical success factors for predicting the quality of life for patients with asthma now and in the future. Research supports the use of a defined set of treatment protocols for assisting patients with asthma lead a better quality of life. The basis for treatment, anatomy and physiology of the respiratory tract and pathology of asthma in patients are all discussed in greater detail below. Normal Lung Function and Respiratory System The human body has two lungs located on either side of the chest. The lungs functions include passing oxygen from outside the body into our bloodstream and releasing waste materials in the form of carbon dioxide back into the environment (Gershwin & Klingelhofer, 1992). During each breath the body inhales oxygen and exhales carbon dioxide (Polk, 18). Oxygen combines with carbohydrates and fat in the body to product energy. During the process of creating energy water and carbon dioxide are formed that are expelled through breathing. The lungs consist of several anatomical structures including the bronchial tubes that enable expansion and constriction of the muscles in the lungs and chest. These tubes consist of muscles that allow air to pass deep in to the lungs. Bronchial tubes consistently change width, increasing in girth as an individual inhales and becoming narrower upon exhalation. In a person with a well functioning respiratory system all parts of the airway function synergistically to ensure maximum intake of oxygen and exhalation of carbon dioxide with each breath. Air enters the body through the nose and mouth. It passes through the pharynx, larynx and trachea, all important parts of the airway (Polk, 18). The noses and sinuses act as conditioners adjusting the air temperature as it passes through other structures in the airway. The pharynx or back of the throat allows liquids and solids entering the airway to â€Å"drop out before entering the lungs† (Polk, 19). Likewise the larynx helps prevent other unwanted particles in the air from entering the lungs (Polk, 19). It is here that the body's cough reflex lies. If something unwanted is present in the air being inhaled, the larynx will stimulate a cough reflex to help expel the object. While the larynx isn't the only trigger for a cough reflect it is very important to the entire breathing process (Polk, 19). When a person inhales, the chest muscles in the body contract allowing the ribs to separate slightly. Air is then drawn into the lungs. The opposite happens when an individual exhales, allowing air to forcefully come out of the lungs. The abdomen is also involved in breathing. The abdomen attaches to the front and back of the ribs, pushing them up and out when breathing. Breathing thus incorporates the chest and abdomen. The more a person engages all the muscles and organs involved in respiration including the abdomen, the better able they are to take a full breath of air. In times of old doctors ascribed asthma to anyone having difficulty breathing regardless of the cause; during the 20th century however researchers refined asthma to include difficult breathing â€Å"Because of a problem that begins in the bronchial tubes of the lungs† (Polk, 15). Asthma is a complex disorder that doctors are still working to fully understand. While doctors have uncovered many potential causes for asthma, they are still not certain what exactly causes it and how to prevent it 100 percent in all patients. In patients with asthma, the ability of the bronchial tubes to adjust their width is often diminished, resulting in difficulty breathing. Children are often at increased risk for developing asthma, as their bronchial tubes are narrower to begin with than adult tubes, thus less change in width is evident even in healthy lungs. Exercise induced asthma is a form of asthma that results when the air present in the nose and sinuses isn't prepared appropriately to pass through other parts of the airway (Polk, 19). Normally this form of asthma is easier to treat than severe forms of asthma whose cause is unknown (Hogshead, 1989; Guyton, 1991). During a bronchospasm attach involuntary spasms may prevent lung tissue from expanding to their normal size. Air can become trapped in the lungs. Cellular and structural changes often occur within the airway and lungs of patients with asthma, including thickening of the airway wall and inflammation (Saetta & Turato, 2001). Normally as air passes through the lungs the bronchiols or airways get smaller. In a patient with uncontrolled asthma however, the sides of the airways typically become enlarged or inflamed (CDC, 2005). During an acute attack, the muscles or bronchiols surrounding the airways constrict, thus reducing the amount of air a person can pass in and out of their lungs (CDC, 2005). Once this constriction begins, mucus starts forming in the airways, causing even greater constriction and distress. Typical symptoms associated with an asthma attack include wheezing, chest pain and tightness, coughing and difficulty breathing (CDC, 2005). No one is immune from asthma. Children, adults and the elderly are all at risk. Some people are more at risk than others including people who smoke, those with seasonal allergies and anyone with recurring acute respiratory infections (CDC, 2005). Signs of asthma include physical qualities of the disease a patient, family member or doctor can easily identify such as dyspnea (trouble breathing) (Polk, 7). Symptoms include complaints generally associated with the condition, and may include headaches or chest pain, skin flushing and itching (Polk, 8). Dyspnea results from multiple conditions other than asthma including infections, allergies, foreign bodies present in the airway and associated factors (Polk, 8). It is important a clinician differentiate between asthma and other causes of the disease. Basis Contemporary Treatments For Managing Asthma The National Asthma Education and Prevention Panel consistently work with doctors to develop contemporary treatments to manage asthma (Moonie, et. al, 2005). Many of these treatments are based on empirical research that supports reduction of patients symptoms and prevention of chronic attacks. The goal of contemporary asthma care and treatment includes â€Å"control of asthma and good quality of life for asthmatic patients† (Gaga, et. al, 80). The basis for much of contemporary care is empirical based research, though trends are changing in an attempt to encourage doctors to improve patient awareness and education. Many asthma drugs historically are administered through inhalation. Inhalers are often prescribed â€Å"on an empirical basis rather than on evidence based awareness: (Virchow, 24). Much of the asthma management guidelines currently available offer â€Å"non-specific advice regarding inhaler choice† (Virchow, 24). As such it is important that GP work with patients to decide what the ideal inhaler is for all patients involved. The ideal inhaler according to Virchow (2005) is one that (1) is breath activated, â€Å"releasing medication only when all prerequisites for successful inhalation are met, (2) has a low intrinsic airflow resistance so children and elderly patients may use it and (3) is one that provides a flow-independent deposition of drugs in the lungs as well as feedback that reassures patients whether the drugs has been inhaled properly (24). Newman (2005) suggests the pressured metered-doze inhaler or pMDI delivers asthma medications in a reliable â€Å"multi-dose presentation† (1177). Key components of this devices help determine the amount of drug delivered to the patient. The researcher further suggests that pMDIs can be developed that are breath actuated and coordinated with â€Å"spray-velocity modifiers† to help patients unable to use â€Å"conventional press and breathe pMDI's correctly† (Newman, 1177). Modern or contemporary pMDI's according to Newman should also contain non-ozone depleting propellants, a sentiment confirmed by Virchow (2005) as well. Patients with severe refractory asthma require more comprehensive treatment. High-doses of inhaled corticosteroids are often insufficient for treating this form of asthma. Most require contemporary treatments including oral corticosteroid administration and use of immunosuppressants (Sano, Adachi, Kiuchi & Miyamoto, 2005). Chronic use of these drugs however present a high risk for adverse side effects. A study conducted by Sano, et. al (2005) suggests that nebulized sodium cromoglycate â€Å"is expected to be a new second-line therapeutic option in severe asthma† (1). Gaga, et. al (2005) suggests that many doctors are not achieving good quality of life and control of asthma for patients. Their study of treatment outcomes for asthmatic patients in specialized care suggests that contemporary treatments should include more patient education combined with increased use of LABAs (Long-acting beta2-agonists) and leukotriene antagonists to help prevent bronchoconstriction and improve quality of life for patients. Despite multiple contemporary treatment choices, managing acute severe asthma attacks still present a tremendous health challenge to health care professionals (Barnard, 2005). Contemporary guidelines for treating acute emergency attacks currently include treatment with oxygen and inhaled beta 2 agonists, which can be administered continuously to help preserve life in acute patients (Barnard, 532). Patients discharged after such treatment should also engage in review of current medications and consider â€Å"a short course of oral steroids, a written asthma action plan and detailed advice about deterioration that may occur within 48 hours† (Barnard, 533). Butz et. al, (2005) are among a growing body of contemporary researchers that suggests that self management and patient education are critical success factors for treating patients with asthma in modern society. Their studies suggested home based educational programs that focus on accurate symptom identification and demonstration of â€Å"asthma medication delivery services† may improve patient quality of life and assist children with asthma and asthma like conditions (Butz, et. al, 190). Delaronde, Peruccio & Bauer (2005) find that â€Å"individualized telephonic case management† from registered nurses specifically trained in contemporary asthma treatment may improve asthma medication use and subsequent quality of life for patients with asthma (361). This research correlates with a growing body of evidence supporting patient education and direct support as practical contemporary treatment practices. The basis for much of contemporary treatment lies in the gold standards or clinical practice guidelines outlined by the National Asthma Education and Prevention Program's Expert Panel (CDC, 2005). These standards offer patients and health care practitioners specific guidelines for recognizing, diagnosis, treating and providing ongoing care to asthmatic patients. Because asthma is a difficult disease to diagnose, clinicians should utilize multiple diagnostic tools to determine whether airflow obstruction in patients results from asthma or other underlying conditions. Doctors should also acquire a comprehensive medical and family history and attempt to quantify the severity of a person's condition (CDC, 2005). Other contemporary diagnostic criteria helpful for assessing a patients condition include lung function tests (also referred to as spirometry) (CDC, 2005). Because there is no cure for asthma at this time doctors must work to improve the quality of life for patients presenting with asthma as effectively treat acute attacks. Doctors also work with patients to prevent attacks and recurrent episodes. Not one treatment modality works for all people because every case of asthma is unique. Because of this doctors often use various medications including injections, oral medications, vapors and inhalers. Use of inhalers to expand airflow is currently one of the most common and effective long-term treatment choices for patients with asthma. Contemporary long lasting medical treatments should include use of corticosteroids to help reduce inflammation in the lungs and airways. Most patients will inhale these medicines or take them orally. Long acting beta2-agonists are also identified as effective long-term treatments for patients with asthma. While inhalers, nebulizers and other medications all serve the asthmatic population, education should also form the foundation for modern treatment practices. Multiple researchers have concluded that patient education is effective for improving the quality of life in patients with asthma. Education also ensures that patients understand how to use their medications and do use them to prevent acute attacks. Education may be particularly beneficial for children by helping them adopt healthy behaviors early on that can help control their condition. Asthma is a complex disease involving structural and physiological components. Patients with asthma face a life long and often debilitating condition that under severe circumstances may result in increased morbidity. Fortunately there are many treatments currently available that effectively manage this condition. Contemporary management and treatment of asthma is based on empirical research that suggests multiple forms of medication for preventing and treating acute asthma attacks. The most common forms of treatment include corticosteroid administration through inhalers or oral forms. There are other equally effective medical treatments however that may work well for patients depending on the severity of their illness. No two patients are alike with respect to the condition thus treatment must be tailored to the individual. New research suggests that doctors and patients focus on prevention and education to help improve patients quality of life and experience of their disease (West, 1990). Education that starts early, as when patients are children, is likely to be more effective than education that starts years after an individual has attempted to manage their disease using other methods. Adequate evidence suggests that the manner of delivery for education does not impact a patients success rate. Thus information may be distributed in person, in the home or even over the telephone if necessary. The currently body of literature available suggest that education in the classroom may also be an important avenue for teaching prevention and treatment in the future (West, 1990). It is important that researchers and doctors continue exploring new avenues for treating and preventing this insidious disease.