Use of Azithromycin for Asthma Patients

Use of Azithromycin for Asthma Patients Does adding azithromycin to standard therapy for asthma patients with acute exacerbations improve symptom resolution? Background: ÂÂ  Asthma is presented as a chronic long term disease that causes inflammation, narrowing and mucus production in the lungs airways resulting in difficulty breathing. It is assumed to be initiated by genetics or environmental influences. Physical activities and other contributing factors can exacerbate asthmatic symptoms that include coughing, wheezing, shortness of breath, and chest tighten. Most patient symptoms occur at a rapid onset and requires immediate treatment. Asthma is not curable but symptoms can be controlled with appropriate therapy. Patients with asthma are given treatment based on the severity and frequency of symptoms. Therapy options include SABA, LABA, corticosteroids or leukotrienes and adjustments are made as needed. However, many patients still experience uncontrolled symptoms that effect their daily activities. Macrolide antibiotics such as azithromycin have been recently studied as adjunct therapy for asthmatics, due to their anti-inflammatory and antimicrobial properties. Researchers are geared to believe that untreated bacterial infections within the lungs are the underlying influences of asthma related problems. Despite these findings, the issue is still being investigated as patients on traditional standard therapy are still experiencing unwanted symptoms. Literature Search A literature search was conducted utilizing the MEDLINE database of Pubmed using MESH terms asthma and azithromycin and MESH subheading therapy. The terms were combined using AND which returned 37 articles. The application of additional limitations of 5 years, randomize controlled trials and humans were applied which reduced the search total amount to 17 articles. Although 17 articles were retrieved during the search, each article was evaluated based on their relevancy and criteria, the above article was selected because it addressed the question at hand. Results AZIthromycin in Severe ASThma (AZISAST) was a randomized double-blinded placebo control trial conducted to determine if adding azithromycin to asthmatic patients as standard therapy would be statistically and clinically beneficial.ÂÂ   The trial was conducted from September 2011 to April 2014, as a United Kingdom multicenter study. The study consisted of individuals ages 18-75 that had been diagnosed with persistent asthma. Inclusion criteria consisted of patients whose current therapy included high doses of inhaled corticosteroids, inhaled long acting beta agonist LABAÂÂ   for six months prior to the study, two severe asthma exacerbations required systemic steroid therapy, or if they experienced a lower respiratory tract infection that required antibiotic treatment within a twelve month period2. Subjects were excluded if they had prolong QT interval, severe bronchiectasis, currently receiving macrolide treatment in past three months, laboratory abnormalities, pregnant or b reastfeeding and concomitant anti-IgE treatments2. Participants were randomly selected to receive to 250mg capsules of azithromycin (n=55) and a placebo (n=54) in combination with inhaled corticosteroids and LABAs for six months2. Subjects in both treatment groups were matched in respect to the baseline characteristics. The intervention instructed patients to take one capsule daily for five days and continue with one capsule three times a week with a total treatment period of twenty-six weeks. The primary outcome measured severe asthmatic episodes during the treatment phase in both groups, which was defined as hospitalization, emergency department visits, and the utilization of systemic corticosteroids for three days2. Secondary outcomes measured lung function (FEV1), peak expiratory flow (PEF) quality of life (QOL) and asthma control score2. Analyzing the secondary outcomes, the azithromycin group reported a number of thirty exacerbations occurred in comparison to twenty-seven form the placebo group. (p=1.000)2. Additionally, azithromycin and placebo group experience two hospitalization admission due to exacerbations (p=1.000)2. Other efficacy outcomes showed there was no significant improvement in the Asthma Quality of Life Questionnaire score between both groups. The treatment period lasted for six months and demonstrated no significant difference between the azithromycin group and the placebo group in relation to asthma exacerbations. The estimated primary endpoints without adjustments resulted in 0.71 (95% CI 0.52 to 0.97) in the azithromycin group and 0.80 (95% CI 0.59 to 1.07) in the placebo group with a p-value of 0.6002. With the addition of sensitivity analyses restricted to asthma exacerbations results were 0.55 (95% CI 0.38 to 0.78) in the azithromycin group and 0.52 (95% CI 0.36 to 0.75) in the placebo group with a p-value of 0.8472. Based on the aforementioned data, add-on therapy of azithromycin is statistically and clinically insignificant, as well as did not reduce the rate of asthma exacerbation in adults. Recommendations Although, the clinical trial failed to demonstrate that azithromycin was clinically /statistically significant in patients with asthma. This should not be a definite factor to rule out the therapeutic benefits azithromycin can have on patients with respiratory infections that contributes to asthma exacerbations. Developing an accurate interpretation from the study can be difficult considering the study focused on a small population and the duration of treatment was only twelve weeks. I would not recommend azithromycin as add-on therapy for patients with asthma due to it showed no improvement in comparison to patients receiving a placebo, as well as long-term use of a macrolide might lead to resistance. References Brusselle GG, VanderStichele C, Jordens P, et al. 2013. Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicenter randomized double-blind placebo-controlled trial Thorax 2013;68:322-329. 10.1136/thoraxjnl-2012-202698mm

Incarcerated Black Males :: Sociology African American

Black Incarcerated Males For the past two decades, the criminal justice system in the United States has been undergoing a tremendous expansion. There are now more than one million black men in jail and that one out of every four black males will go on prison in there lifetime. Knowing these statistics it put a burden on the black community because many families are left with single family home, the unemployment rate for black male go up, they can not vote and now they make jail seem like it is fun to go to. Black men in Jail are having drastic effects upon the black community. The first and arguably most important effect is that it intensifies the problem of single parent households within the black community. When these men are sentenced to prison, they, many times, leave behind a wife/girlfriend and/or children. If they have already have had children, that child must spend multiple years of his/her early life without a primary father figure. In addition, that male's absence is even more prominently felt when the woman has to handle all of the financial responsibilities on her own. This poses even more problems since women are underpaid relative to men in the workforce, childcare costs must be considered, and many of these women do not have the necessary skills to obtain a job, which would pay a living wage, which could support her and the children. Black male incarceration has done much to ensure that black female-headed households are now equal with poverty. Black male imprisonment also has much to do with rising black male unemployment rates. As these men re-enter the workforce they now likely have less skills than when they first entered prison. There are few, if any, programs, which train these men to effectively re-enter society. As jobs continue to move out further and further into the suburbs, these males, who are from the inner city, are left with few living wage employment options. The rates that convicts go back to jail are so high not because these men want to return to a life of crime but since few employment options are available, they tend to utilize their limited skills to get the money they need to survive. If more efforts do not make additional training available to these males that are realistically designed to help them obtain a living wage job, the rates that convicts go back to jail and black male unemployment will continue to increase.

Client-Server Networking Essay Essay

The problem in the given scenario for the user is that the new driver installed to be compatible with the graphics adapter was not downloaded correctly or was incomplete. This is what causes the secondary malfunctions with the screen. When he was seeing the wavy lines it meant that the driver needed to be updated to use the new graphics adapter. He then checked the device manager and saw that it could be updated. He did so and restarted the computer afterwards. As it started he began hearing the noises because the driver was not downloaded correctly. And he then lost the display and could not diagnose the issue properly. In order to resolve this issue you must first restart the computer. As it comes back up from restarting you would put it in safe mode. It should give you the option to do this like it does to start windows normally. Now that you are in safe mode you are able to use a generic graphics driver that it has within it. But you must first uninstall the new driver that was showing the issues and re-install the driver you have before. From here you just wait for the next compatible driver for that graphic adapter to come out for use. Do not attempt to download the new driver again. From there your issue is temporarily resolved.

Ray Bradbury s Fahrenheit 451 - 976 Words

The life of protagonist Guy Montage from Ray Bradbury’s novel Fahrenheit 451 would be similar to life without a choice. Bradbury’s novel Fahrenheit 451 demonstrates how excessive use of technology affects a person’s relationship. Montage is the protagonist of the novel who is a fireman. Montage lives in a world where his job is to burn books, and initiate a fire. The government is trying to outlaw the use of books in the city. Bradbury portrays this new world through the character of Montage. Bradbury describes Montage’s world where the government is prohibiting the use of books for the sake of their happiness. Bradbury portrays the issues concerning the overuse of technology and its implications on citizens’ and their daily life. The restricted lifestyle, fake entertainment, and abuse of technologies have vital effects on individuals and their relationships with their family members. In the novel, Guy Montage, whose, job is to burn books because i t is not allowed in their states. For those, who are caught using the book are punished and arrested. Instead of reading the books, the citizens have to listen to radio and watch TV. The novel opens with Montage meeting Clarisse, who happens to be his neighbor, over time it turns into a friendly relationship. Both discuss the issues that they are facing in the society; that no one is willing to do anything to make this society better place. One day, montage finds out Clarisse has disappeared and is very upset about it. UponShow MoreRelatedRay Bradbury s Fahrenheit 4511721 Words   |  7 Pagesliterature slowly disappear from the minds of the population? This is the question that Ray Bradbury’s novel, Fahrenheit 451, attempts to answer. In this book, he describes a hypothetical world in which the population not only avoids reading, but has made owning books an unthinkable crime, with all books discovered burned, along with the houses of those who hoarded them. In this dysto pian future created by Bradbury, the beauty that is literature has been replaced in society by television programs andRead MoreRay Bradbury s Fahrenheit 4511358 Words   |  6 Pagesnotice them, books were outlawed, knowledge was forbidden, and memories were hard to come by? In the 1950 novel Fahrenheit 451, author Ray Bradbury presents a society which invokes much thought about the way we live in society today. It’s a story about a lifestyle in the future that has evolved from our present, but in seemingly different worlds. Through the protagonist, Guy Montag, Bradbury makes a wider point about the dangers that a society can present. The government of this future forbids itsRead MoreRay Bradbury s Fahrenheit 4511360 Words   |  6 Pages Ray Bradbury and his Fahrenheit 451 Future Technology has had many great contributions, but is it destroying America as author Ray Bradbury foreseen back in the 1950’s. The intent of this paper is to explain how Fahrenheit 451, which was written over 65 years ago, has begun to come true in some aspects of American society today. The intended audience for this paper is fellow students who have not read this novel, and the professor. Ray Bradbury’s role in Fahrenheit 451 is to help readers understandRead MoreRay Bradbury s Fahrenheit 4511120 Words   |  5 Pagesindividuality suppression, and the ever-growing gap between upper and lower class. The United States is heading down the path of becoming a dystopian society. Citizens in the United States have the same general behavior as those in Ray Bradbury’s novel, Fahrenheit 451. This novel features a world where cars are fast, music is loud, and watching television is the main way to spend free time. People rarely make time for each other, rarely imagine and form their own opinions, and rarely take the timeRead MoreRay Bradbury s Fahrenheit 4512532 Words   |  11 PagesRay Bradbury’s Fahrenheit 451 is a magnificent masterpiece written to aid in visualizing what a distant future dystopian society would look like; one in which everyone lives in the fast lane, technology is at its crowning, void of human relations and instant satisfactions, as well as gratifications, are constantly being pursued. The novel was written during the era where communism and the holocaust began to sprout. Mr. Bradbury, being a patriot of his country, feared that society was leaning towardRead MoreRay Bradbury s Fahrenheit 4512451 Words   |  10 PagesRay Br adbury’s Fahrenheit 451, is a prime example of social criticism. The story sets in the 24th century where people race jet cars; the author’s idea of the future. It shows a flawed social structure, controlled by the media and government with banning and burning of books, and suppressing society’s minds from history. Their logical thought was that it would keep society from thinking too much, which in turn would prevent bad thoughts, and to keep them â€Å"happy all the time†. The book tells a storyRead MoreRay Bradbury s Fahrenheit 4511410 Words   |  6 PagesRay Bradbury’s Fahrenheit 451, published in 1953 by Ballantine Books, rose to fame quickly and surely as a grandfather of the dystopian genre. A year after its release, Greg Conklin of Galaxy Science Fiction named the novel, â€Å"among the great works of the imagination written in English in the last decade or more† (Conklin). The Chicago Sunday Tribune s August Derleth called it a s hockingly savage prophetic view of one possible future way of life, while honoring Bradbury in sight of his brilliantRead MoreRay Bradbury s Fahrenheit 4512323 Words   |  10 Pagesnot accepted, or even worse, a detached society where emotions no longer exist. By reading the first few pages of Fahrenheit 451, readers immediately get the feeling of a dystopian society. Firemen creating fires, instead of extinguishing them, and technology that has taken their society to a whole new level of entertainment. These are exaggerated ideas right off the bat, yet Ray Bradbury carries the readers through the story in order to show them his own outlook on the future- in fact, all dystopianRead MoreRay Bradbury s Fahrenheit 4512071 Words   |  9 Pageslives? In the book Fahrenheit 451, Ray Bradbury depicts a society that is immersed in technology, which becomes an obsession for most of its people. Bradbury also describes the negative effects that come with this technology, especially losing essential human traits like communication and common sense. Finally, Bradbury sends the message that technology is so powerful that it not only controls certain people, but an entire society as well. In the book Fahrenheit 451, Ray Bradbury describes the dangersRead MoreRay Bradbury s Fahrenheit 4511592 Words   |  7 Pagessomething real?†(pg) Ray Bradbury s book Fahrenheit 451 although written in 1953, was ahead of its time predicting technological marvels and our potential to indulge and be addicted to electronic media. The novel presents a twilight zone of what society could be like if books and the written word were no longer desired and the main purpose of life becomes the hunt for personal happiness. So, has our society already evolved into these habits? I cannot help but say Bradbury s description is comparable Ray Bradbury s Fahrenheit 451 - 976 Words â€Å"Fire is dangerous,† is what my mother always told me. Growing up with a mother that harped about playing with fire turned that very thing into my biggest fear. When I was younger, I had a repeating nightmare that my house would burn down in the middle of the night, and sometimes I would get stuck inside; other times I would escape and be purely mesmerized by both the danger and the beauty that the blaze held. This mesmerizing impression is brought to life in Ray Bradbury’s novel Fahrenheit 451. Bradbury employs many different human associations and responses to fire throughout the novel. In fact, the image of fire is the most dominant image used in Bradbury’s Fahrenheit 451. Bradbury presents fire in many different ways in the novel, such as, a destroyer, things of beauty, and a restorer. In the beginning of the novel, fire is seen as a destroyer. The setting in Fahrenheit 451 is in a futuristic, totalitarian society. It is obvious that when the novel begin s that destruction by fire is seen as a good thing. Ray Bradbury starts Fahrenheit 451 by giving insight as to how Guy Montag feels, â€Å"It was a special pleasure to see things eaten, to see things blackened and changed† (1). I feel as if most people first perceive fire as dangerous and see it in a negative light. People are taught first to fear fire as children until they are old enough to better understand that although it is destructive, it can be used for good. Montag, seems strangely pleased with himself after heShow MoreRelatedRay Bradbury s Fahrenheit 4511721 Words   |  7 Pagesliterature slowly disappear from the minds of the population? This is the question that Ray Bradbury’s novel, Fahrenheit 451, attempts to answer. In this book, he describes a hypothetical world in which the population not only avoids reading, but has made owning books an unthinkable crime, with all books discovered burned, along with the houses of those who hoarded them. In this d ystopian future created by Bradbury, the beauty that is literature has been replaced in society by television programs andRead MoreRay Bradbury s Fahrenheit 4511358 Words   |  6 Pagesnotice them, books were outlawed, knowledge was forbidden, and memories were hard to come by? In the 1950 novel Fahrenheit 451, author Ray Bradbury presents a society which invokes much thought about the way we live in society today. It’s a story about a lifestyle in the future that has evolved from our present, but in seemingly different worlds. Through the protagonist, Guy Montag, Bradbury makes a wider point about the dangers that a society can present. The government of this future forbids itsRead MoreRay Bradbury s Fahrenheit 4511360 Words   |  6 Pages Ray Bradbury and his Fahrenheit 451 Future Technology has had many great contributions, but is it destroying America as author Ray Bradbury foreseen back in the 1950’s. The intent of this paper is to explain how Fahrenheit 451, which was written over 65 years ago, has begun to come true in some aspects of American society today. The intended audience for this paper is fellow students who have not read this novel, and the professor. Ray Bradbury’s role in Fahrenheit 451 is to help readers understandRead MoreRay Bradbury s Fahrenheit 4511120 Words   |  5 Pagesindividuality suppression, and the ever-growing gap between upper and lower class. The United States is heading down the path of becoming a dystopian society. Citizens in the United States have the same general behavior as those in Ray Bradbury’s novel, Fahrenheit 451. This novel features a world where cars are fast, music is loud, and watching television is the main way to spend free time. People rarely make time for each other, rarely imagine and form their own opinions, and rarely take the timeRead MoreRay Bradbury s Fahrenheit 4512532 Words   |  11 PagesRay Bradbury’s Fahrenheit 451 is a magnificent masterpiece written to aid in visualizing what a distant future dystopian society would look like; one in which everyone lives in the fast lane, technology is at its crowning, void of human relations and instant satisfactions, as well as gratifications, are constantly being pursued. The novel was written during the era where communism and the holocaust began to sprout. Mr. Bradbury, being a patriot of his country, feared that society was leaning towardRead MoreRay Bradbury s Fahrenheit 451976 Words   |  4 PagesGuy Mont age from Ray Bradbury’s novel Fahrenheit 451 would be similar to life without a choice. Bradbury’s novel Fahrenheit 451 demonstrates how excessive use of technology affects a person’s relationship. Montage is the protagonist of the novel who is a fireman. Montage lives in a world where his job is to burn books, and initiate a fire. The government is trying to outlaw the use of books in the city. Bradbury portrays this new world through the character of Montage. Bradbury describes Montage’sRead MoreRay Bradbury s Fahrenheit 4512451 Words   |  10 PagesRay Bradbury’s Fahrenheit 451, is a prime example of social criticism. The story sets in the 24th century where people race jet cars; the author’s idea of the future. It shows a flawed social structure, controlled by the media and government with banning and burning of books, and suppressing society’s minds from history. Their logical thought was that it would keep society from thinki ng too much, which in turn would prevent bad thoughts, and to keep them â€Å"happy all the time†. The book tells a storyRead MoreRay Bradbury s Fahrenheit 4511410 Words   |  6 PagesRay Bradbury’s Fahrenheit 451, published in 1953 by Ballantine Books, rose to fame quickly and surely as a grandfather of the dystopian genre. A year after its release, Greg Conklin of Galaxy Science Fiction named the novel, â€Å"among the great works of the imagination written in English in the last decade or more† (Conklin). The Chicago Sunday Tribune s August Derleth called it a shockingly savage prophetic view of one possible future way of life, while honoring Bradbury in sight of his brilliantRead MoreRay Bradbury s Fahrenheit 4512323 Words   |  10 Pagesnot accepted, or even worse, a detached society where emotions no longer exist. By reading the first few pages of Fahrenheit 451, readers immediately get the feeling of a dystopian society. Firemen creating fires, instea d of extinguishing them, and technology that has taken their society to a whole new level of entertainment. These are exaggerated ideas right off the bat, yet Ray Bradbury carries the readers through the story in order to show them his own outlook on the future- in fact, all dystopianRead MoreRay Bradbury s Fahrenheit 4512071 Words   |  9 Pageslives? In the book Fahrenheit 451, Ray Bradbury depicts a society that is immersed in technology, which becomes an obsession for most of its people. Bradbury also describes the negative effects that come with this technology, especially losing essential human traits like communication and common sense. Finally, Bradbury sends the message that technology is so powerful that it not only controls certain people, but an entire society as well. In the book Fahrenheit 451, Ray Bradbury describes the dangers