My Decision Making Model Essay

My Decision Making Model BY sals39 My Decision Making Model Experience MMPBU500 July 12, 2010 Mr. Chuck Millhollan Abstract Throughout every day of our lives we are forced to make decisions although at times it is not the easiest task. As a result, decision making models are utilized to ease the burden of making the wrong decisions which have lasting effects. There are numerous decision making models and they each function in various ways. However, my most favorable decision making process is the rational decision making process. It helps to me weigh my options as to what is my best possible choice and clearly epicts the consequences of my final decision. The rational decision making process is a six step process that is utilized extensively in many organizations and schools. The process is used so that decisions made are in the best interest of each situation. According to Janis and Mann, † in rational decision making: (a) the goals and objectives of decision makers are clear and known in advance; (b) the decision maker chooses the best alternative among all possible courses of action; (c) full information about the consequences of possible courses of action is available; and (d) there is no uncertainty involved†(Decision aking, 2001). As an elementary educator, I frequently make decisions and tend to utilize the rational decision making process as I do so. Problem Defining the Prior to any decision making process being used there must be a problem or situation on hand. The first step is defining the exact problem and it can be easily overlooked. It helps to avoid misinterpretations of the problem and uncommon solutions especially when working with others. For instance when we are conducting grade level meetings we normally begin by individual stating problems that we have been encountering individually in the classroom. We then merge those individual issues and find one root that is the cause of those issues and target it as our main problem. Research Pros and Cons In every situation after establish the problem it is then possible to research how to eliminate the problem and the pros and cons of doing such. According to the Macquarie Dictionary, when we evaluate the pros and cons of a decision we are â€Å"establishing the arguments for and against something† (Macquarie, 2010). As a result we then, formulate solutions and the good and bad of each solution. It helps us to consider every possible option and recognize consequences, if any. This in students. Making a Decision and Formulating a Plan When making decisions especially within a group it can be very time consuming and requires a lot of thought. After weighing the pros and cons one should be able to make the best possible choice that is going to benefit the situation. As we progress to making a decision in our grade level meeting we aim to come to once consensus which is normally done by taking a vote based on our findings. When then immediately begin brainstorming ways in which we can get our ideas and decisions into actions by formulating a plan. We establish our weekly plan which is a detailed escription of the daily activities and lessons that is carefully executed by all teachers within that grade level. We then schedule or next grade level meeting to evaluate the outcome of our decisions and plans to solve them. Evaluate Results Why establish a plan and do not evaluate the productivity or outcome? No matter the situation it is always of best interest to evaluate any plan put in place to rectify a problem. It is done by reevaluating the problem, the solutions that were presented, the plan that was put in place, and how well the plan was executed and succeeded in alleviating the problem. At the beginning of our weekly grade level meetings we use the first ten minutes to evaluate prior plans that were put in place and whether they were effective or not. At that point we are able to make the necessary alterations needed or express what portions of the plan was successful. Conclusion The rational decision making model help to ensure order and consistency is established into making your decision. It also provides a well thought-out and orderly approach to decision making. It helps make certain we consider all factors relating to a decision, in the most reasonable manner.

Definition and Examples of Drawl

Definition and Examples of Drawl Definition A drawl is  speech that is characterized by drawn-out vowels and syllables. This informal term is often used by non-linguists in a pejorative way. Contrary to popular belief, Americans in the southern states dont pronounce words more slowly than other speakers of American English. The phenomenon perceived as  a drawl is  a result of adding glides to vowels to create diphthongs and triphthongs. Words may seem slower because they contain more sounds (World Englishes Vol. 2: North America, 2012).   See Examples and Observations below. Also see: AccentAccent PrejudiceBrogueDiphthongLinguicism Voice (Phonetics) Examples and Observations [The mission of Trident submarines] is to launch a massive and final lethal blow in the event that the worst has happened: nuclear combat toe-to-toe with the Ruskies, in the memorable drawl of Major T. J. King Kong, the Slim Pickens character in Dr. Strangelove.(Timothy Egan, Run Silent. Run Deep. Run Obsolete. The New York Times, July 14, 2010)All of the children of the Fox say feerst for first, beerst for burst, theerst for thirst. Why, no one knows. It seems to be a tribal accent, not only among all of Foxs children, but among all of their young cousins on the Foxs side. It is almost as if they were creatures of some isolated family, immured for generations on some lonely island, cut off from the world, and speaking some lost accent that their ancestors spoke three hundred years ago. Moreover, their tone is characterized by a kind of drawlnot the languorous drawl of the deep South, but a protesting drawl, a wearied-out, exasperated drawl, as if they have almost given up hope of ma king Foxor someoneunderstand what ought to be obvious without any explanation whatsoever.(Thomas Wolfe, You Cant Go Home Again, 1940) When it started kicking off, someone said to me, This is your time in the sunshine, [John] Bishop explains in a warm Liverpudlian drawl so thick it’s as if his words are forming in a cement-mixer. That sentence hit home because it really feels like that.(Dominic Cavendish, John Bishop: Ordinary Bloke, Comedy Star. The Daily Telegraph, August 6, 2010)Xiaowei had mastered those tricky English irregular verbs, perfected a convincing American drawl and could rattle off the 10 biggest U.S. cities by heart.(Hannah Beech Shanghai, High Hopes. Time magazine, December 17, 2001) The Southern DrawlThere are two distinct interpretations of the term southern drawl: the common or folk notion and the linguistic definition (Montgomery 1989a: 761). In common parlance, the southern drawl is a synonym for southern accent or southern speech and refers to the putative slowness of southern speech, often attributed to the heat or to the laziness of its speakers. It is thus often used derogatively, a s is the term brogue or even the term dialect itself. In contrast, linguists use the term to refer to the lengthening and raising of accented vowels, normally accompanied by a change in voice pitch. It involves the addition of a second or even a third vowel but does not necessarily entail a slower overall speech tempo (Montgomery 1989a: 761).(George Dorrill, The Phonology of English in the South. English in the Southern United States, ed. by Stephen J. Nagle and Sara L. Sanders. Cambridge University Press, 2003) Tom Wolfe on the Drawl of the Airline PilotAnyone who travels very much on airlines in the United States soon gets to know the voice of the airline pilot . . . coming over the intercom . . . with a particular drawl, a particular folksiness, a particular down-home calmness that is so exaggerated it begins to parody itself (nevertheless!its reassuring) . . . the voice that tells you, as the airliner is caught in thunderheads and goes bolting up and down a thousand feet at a single gulp, to check your seat belts because it might get a little choppy . . ..Well!who doesnt know that voice! And who can forget it,even after he is proved right and the emergency is over.That particular voice may sound vaguely Southern or Southwestern, but it is specifically Appalachian in origin. It originated in the mountains of West Virginia, in the coal country, in Lincoln County, so far up in the hollows that, as the saying went, they had to pipe in daylight. In the late 1940s and early 1950s this up-holl ow voice drifted down from on high, from over the high desert of California, down, down, down, from the upper reaches of the Brotherhood into all phases of American aviation. It was amazing. It was Pygmalion in reverse. Military pilots and then, soon, airline pilots, pilots from Maine and Massachusetts and the Dakotas and Oregon and everywhere else, began to talk in that poker-hollow West Virginia drawl, or as close to it as they could bend their native accents. It was the drawl of the most righteous of all the possessors of the right stuff: Chuck Yeager.(Tom Wolfe, The Right Stuff, 1979)

Cesar Chavezs Use of Antithesis and Diction to Portray His Beliefs on the Argument on Why Nonviolent Resistance Trumps Violent Resistance

Cesar Chavez's Use of Antithesis and Diction to Portray His Beliefs on the Argument on Why Nonviolent Resistance Trumps Violent Resistance Ten years following the assassination of Dr. Martin Luther King Jr., people still protested and empathized on behalf of his death, but labor union organizer and civil rights leader Cesar Chavez argues as to why nonviolent resistance, trumps violent resistance. Chavez is able to portray his belief to the people through his strong use of antithesis and diction, and while even alluding to a historical leader whose views and beliefs are still extremely well known today. Through his use of strong rhetoric, and specific examples Chavez is able to solidify his argument in favor of nonviolent resistance. Throughout the article, Chavez uses antithesis to contrast the cons of violent resistance, with the pros of his argument for nonviolent resistance. Chavez first shines light to one of the pros of nonviolent resistance when he claims that, â€Å"Nonviolence provides the opportunity to stay on the offensive, and that is of crucial importance to win any contest.† Chavez is trying to get the point across that it is better to stay on good, and safe terms, rather than â€Å"fighting fire with fire,† because that can easily get violent, dangerous, and out of hand fast. Chavez juxtaposes this idea of being civil and not, â€Å"fighting fire with fire,† with cons of violent resistance when he says that, â€Å"If we resort to violence then one of two things will happen, either the violence will be escalated and there will be many injuries and perhaps death on both sides, or there will be total demoralization of the workers.† Both the outcomes that Chavez portrays as a result of violent resistance are bad, and Chavez takes advantage of this situation in order to continue advocating for nonviolent resistance by soon after stating, â€Å"Nonviolence has exactly the opposite effect.† Chavez finally puts to rest his portrayal of the negative consequences of violent resistance after he says, â€Å"Violence does not work in the long run and if it is temporarily successful, it replaces on violent form of power with another just as violent.† This statement ends his juxtaposition against violent resistance, leaving the reader with a chance to think about the truth of this statement, and as seen through history this statement proves rather accurate. Chavez uses strong diction in an effort to persuade the reader to advocate for nonviolent resistance. When Chavez first begins to argue against violent resistance, he uses powerful words such as â€Å"escalated,† and â€Å"demoralization,† to describe the negative effects of violent resistance. The words have a negative connotation in the context that they are used, which adds to the argument against violent resistance. Chavez uses this diction in this specific paragraph because this is the first time he truly introduces the idea of violent resistance, and he wants to immediately make it appear bad, and negative. Another instance in which Chavez uses strong diction is when he uses the words â€Å"frustration,† and â€Å"impatience,† in order to express how he is aware of how people feel frustrated, impatient, and angry, but he follows this up by saying that is no reason to resort to violent resistance, because eventually things will work out. It is throu gh his strong use of diction, that Chavez is further able to leave a lasting impression on the reader as to why nonviolent resistance is a far more reasonable, and effective form of resistance. Chavez continues to argue in favor of nonviolent resistance, by alluding to Mahatma Gandhi, one of the most famous men in the world, who is known for his firm stance on nonviolent resistance. Gandhi was able to lead India to its independence without any use of violence. By alluding to Gandhi, Chavez is making an effort to prove to readers that things can get done without the use of violence, and the story of Gandhi shows just that. Chavez’s use of antithesis clearly portrays his reasoning as to how the pros of nonviolent resistance, outweigh the many cons of violent resistance, and through his use of strong diction, and an allusion that shows historical proof that nonviolent resistance is an effective strategy, Chavez is able to make a strong case for nonviolent resistance.

Management Essay Example | Topics and Well Written Essays - 1500 words - 9

Management - Essay Example It was acknowledged that Herzberg related need satisfaction to job conditions: job content and job context; where the job content factor was specifically identified a motivators (Martires & Fule, 2010, p. 15). The aim of the current discourse is to determine lack of job satisfaction and motivation as a contemporary management issue through the use of current events that were published on the subject. Identification of a Contemporary Management Issue In an article entitled â€Å"10 factors creating job satisfaction: what motivates now?† written by Spicer (2010) and published online in the Bradford University School of Management, the author actually delved into a closer evaluation of factors which apparently have been perceived as contributory to motivation. The author sought the participation of an original number of 268 managers across UK and Europe. As disclosed, there were â€Å"10 longstanding factors that research identifies as significant in influencing people’s motivation† (Spicer, 2010, par. 2). The factors were clearly enumerated and presented as Table 1, below: Table 1. Ten Longstanding Factors that Significantly Influence Motivation Factor 2010 2008 Interesting work 1 1 Job security 2 6 Full appreciation of work done 3 4 Good wages 4 2 Promotion and growth in the organization 5 3 Personal or company loyalty to employees 6 7 Feelings of being in on things 7 8 Tactful discipline 8 9 Good working conditions 9 5 Sympathetic help with personal problems 10 10 Source: Spicer, 2010 From the study, it was revealed that the factors most regarded as contributory to job satisfaction in 2010 were: interesting work, job security, and appreciation for work well done (Spicer, 2010). The top factor in 2008 was similar: interesting work, followed by good wages, as well as promotions and growth in the organization (Spicer, 2010). As published in Employee Benefits, â€Å"motivating employees is vital if employers are to achieve maximum performance and productivity. There are a wide variety of methods available for motivating staff, at prices to suit all budgets. These range from recognizing employees' achievements by simply saying 'thank you' to more complex schemes which combine set targets with fixed rewards† (Employee Benefits, 2006, par. 1). This is consistent with Spicer’s findings that acknowledged appreciation for work as a significant motivating factor that contributes to job satisfaction. Concurrently, in another study that aimed to determine the level of motivation and job satisfaction among employees of KFC, UK, the author disclosed that â€Å"non ­financial  factors  have a  significantly  higher  impact  on  the  employee's  motivation than   the  financial   factors†¦(and that)   the  study concluded  that  the  employees  working  at  KFC  UK  Ltd  are adequately motivated, though  a  significant  difference  of  level of motivation wa s   noticed   among   gender,   different   age groups,   working   status,   working   position   and   length   of employment  comparison† (Hossain & Hossain, 2012, p. 21). The study written by Adeyemi and Ositoye (2010) supported the theoretical frameworks on motivation as originally published by Maslow (1954), Koontz, O’Donnel and Weintzrizh (1980) which asserted that â€Å"what really matters in boosting employee productivity or output is not the kind of motivation that is employed but the extent to which the employee is being truly motivated by any chosen method. .. (And) the ability of the employer to identify employee

Examine and discuss the philosophical views developed by Epicurus Essay

Examine and discuss the philosophical views developed by Epicurus - Essay Example They  cannot be created or destroyed  though there can be added or subtracted to provide different structure. He  is of the view that atoms exit in different shapes and he states, â€Å"for so many varieties of things as we see could never have arisen out of a recurrence of a definite number of the same shapes. The like atoms of each shape are absolutely infinite, but the variety of shapes†¦not absolutely infinite† (Epicuris.net 12).These atoms are moving all the time as mentioned in Herodotus, â€Å"The atoms are in continual motion through all eternity (Epicuris.net 13)† Furthermore, Epicurus gave reasons that these invisible atoms were of different sizes that provide different sensations and feelings in people as mentioned, â€Å"Again, you should not suppose that the atoms have any and every size, lest you be contradicted by facts; but differences of size must be admitted; for this addition renders the facts of feeling and sensation easier of explanation† (Epicuris.net p.27). Epicurus did not approve of the idea that there was indivisibility of matter as atoms are not divisible. Epicurus believed that cosmos consisted of many worlds that were endless in number, had their point of origination and ends and were in constant movement. It is mentioned in a letter to Herodotus where he clearly stated that these cannot be divided or changed (Epicuris.net p.9). Epicurus had the view that cosmos could be explained by humanistic experiences as humans could remain happy if they became free of supernatural agents like Gods, fear of life after, punishments. Epicurus had the view that it was the nature of human beings that they associate knowledge of cosmos with facts that should be based on empirical data. However, for Epicurus, human beings sensation is the foundations of any investigations of cosmos. According to him, sciences are still inexhaustible which makes the

Innovative Organisation Case Study Example | Topics and Well Written Essays - 2000 words

Innovative Organisation - Case Study Example The company is reputed as the chief civil production establishment in San Francisco woof Region. Abernathy, W.J., Clark, K. (1985). Through long-term tutoring programs the company has been on the frontline in offering contemporary products and services. One of its competitive strategies has been the cost leadership; the company offers sophisticated design and architectural product that embody the post modern architecture at a relatively reasonable cost than its fierce rivals. Secondly, the company offers a wide range of products and services, this includes; designing of temporary on and offsite parking, helipad relocation design, preliminary site relocation design among others. This myriad service makes it dominate other firms. Thirdly, the company has a regional presence and as such a wider clientele niche. Lastly the integration of technology has been a boast for the company; information flow across the organizational structure has been proficient, ideally this has triggered a boom ing business as the bottle necks have been aborted. The most challenging part on designers has been in meeting of the objectives of a building's utility and in designing facades that challenges and provoke the same functions. Structural buildings are multifarious units that perform important duties; shelter and security to whoever uses the same. Structural edifices also meet clustered requirements to satiate operational demands by means of pragmatic form and also desire to employ nonfigurative compounds to impact on the right mind and nourish the mental power. Abernathy, W.J., Clark, K. (1985), Introduction Innovation is a comprehensive course of action through which an organization engenders resourceful and fresh scientific notion (contraption) and translates them into original, practical and feasible profitable products, services as well as trading performances for (prospective) fiscal advantage. Research findings have indicated that aggressive gain is centered on the capability to generate an economy driven not by cost efficiencies but by notions as well as intellectual expertise. The natural world of novelty has gone through a metamorphosis as such the intrinsic description of novelty has dramatically been altered with time. Conventional definition of innovation was centered on persons that toiled in laboratories, itchy and throbbing just waiting to unmask great discoveries. In the modern society, the attention has shifted away from being an individual entity to a global phenomenon that hinges on collaboration. The Amazon president, Bezos Jeffrey puts it like going down blind alleyw ays (Blayse, A, Manley, K 2005). Yet every time one goes down an alleyway and it opens up into gigantic, expansive boulevard. Novelty begins when we break free and rebuff the inert. Dissimilar to invention, that emerges from endeavor, carrying out tests coupled with an aspect of lack, novelty is embedded closely on expertise and leadership-earmarking prospective places to centre novelty power and designing the idyllic atmosphere for innovation to boom. CEO's play an integral role to making novelty a reality; scientifically or rather methodologically. Analogous to executing a corporate line of attack, realizing novelty entails the making of deliberate choices. Options can copiously exist, yet highlighting and sharpening winning options require ingenuity and this is a role that

Nebulized L-epinephrine in Post -Bronchoscopy Croup

Nebulized L-epinephrine in Post -Bronchoscopy Croup Safety and Efficacy of Nebulized L-epinephrine in Post -Bronchoscopy Croup in Children, Anesthesia Consideration Dr Asma Aref Idamat, Pharmacist Dr Hussein Khraysha, Senior Specialist Anesthetist Dr Najeh Alomari, Consultant Pediatric Surgeon Amman-Jordan ABSTRACT OBJECTIVE: To assess the value of bronchodilator effect of nebulized epinephrine post bronchoscopy in children and to compare the effectiveness and side effects of nebulized L-epinephrine (NLE) 1/1000 at a dose of 0.1 mL/kg versus 0.5 mL/kg in the treatment of post-bronchoscopy croup and upper airway obstruction . MATERIAL AND METHOD: Between April1998 and April 2002, 120 children, who developed signs and symptoms of upper airway obstruction (UAO) after bronchoscopy, were randomized to receive either 0.1 mL/kg or 0.5 mL/kg of nebulized L-epinephrine (NLE). Age group ranged from 4months to 14 years, mean of 4.6 years, male /female ratio 4:1. UAO scores, vital signs (VS) ,oxygen saturation (O2 Sat)and side effects if present were recorded before ,at 15 minutes , 35 minutes and 45 minutes after the treatment. The treatment was accomplished in the recovery room under the care of the anesthetist and pediatric surgeon. All patients were reviewed carefully prior to discharge from recovery room. RESULTS: Sixty children were allocated to the 0.1mL/kg (NLE) and sixty children to the 0.5 mL/kg (NLE).. The (NLE) was mixed with 2ml of normal saline. Both groups showed improvements in UAO scores and Oxygen saturation over time. There were no significant differences in UAO scores and VS between the groups at all time points. There were no side effects of epinephrine during the observation. CONCLUSION: The administration of nebulized L-epinephrine is safe and effective in reliving croup and upper airway obstruction (UAO) post-bronchoscopy in children. NLE at the dose of 0.1 mL/kg results in similar improvements in the UAO scores, compared with the dose of 0.5 mL/kg. No complications were seen in either dose and we recommend the routine use of 0.1ml/kg (NLE) post –bronchoscopy in children. Key words: Bronchoscopy, Bronchodilators, L-adrenaline, croup, children Introduction Croup or subglottic edema post bronchoscopy and post intubation is a well known entity. Children are more vulnerable to develop croup after such procedures than adults due to well known differences in the anatomy of upper airway and tracheo-bronchial tree with narrower laryngeal and tracheal lumens with the result of obstruction more readily by to mucosal edema due to different causes, like viral and bacterial infections as well as allergic manifestations. The narrowest part of upper airway is that at the level of cricoid cartilage which makes the internal tracheal injury by endo tracheal tube or bronchoscope sheath more prone at the narrow subglottic area even after easily passage through the vocal cords. Bronchoscopic removal of aspirated foreign bodies in children is a common procedure in Jordan and many other countries worldwide. The procedure is performed under general anesthesia using rigid bronchoscopic device through which the ventilation is maintained. Foreign bodies are usu ally successfully removed using forceps, wash out with saline and suction tube. In many cases repeated bronchoscopic intubation may be necessary to assure complete removal of foreign bodies with the result of significant irritation and edema to the tracheo-bronchial tree with the sequel of croup, wheezy chest and features of upper airway obstruction (UAO) which may lead to significant morbidity and prolonged hospitalization. The incidence of post intubation croup in children was reported to be between 1 to 6 % (1,2). The medical treatment of postintubation croup is the same as that for infectious croup, including corticosteroids and nebulized epinephrine. The vasoconstrictive effect of epinephrine decreases the degree of subglottic edema, resulting in clinical improvement. Traditionally recemic epinephrine has been used as a non-selective adrenergic agonist of choice in children due to its supposedly fewer side effects than the more active and more readily available natural laevorot atory form of epinephrine. However, there seems to be no pharmacological basis for this belief (3-5) and subsequent trials have shown the L-epinephrine which we use for resuscitation, to be safe and effective in both infectious and postintubation croup(6,7). In addition, L-epinephrine is readily available in all countries while racemic epinephrine is not. Even in countries where both forms are available the racemic form is much more expensive(8 ).It was noted that the doses of L-epinephrine used in those trials were 2.5 and 5 mL of 1:1000 solution for all recruited children, regardless of weight. As a result, the dose of L-epinephrine in the treatment of croup has been suggested to be 0.5 mL/kg, with a maximum dose of 2.5 mL and 5 mL for children younger and older than 4 years, respectively (9). So far there have been very few reports that have studied the efficacy L- epinephrine in the management of post bronchoscpy croup and (UAO) in children. This study was designed for tow purpo ses of: (a) ascertaining the effectiveness of L-epinephrine in the management of croup and weezy chest post bronchoscpy in children or not; and (b) comparing the efficacy of a nebulized L-epinephrine at the dose of 0.1ml/kg versus 0.5ml/kg for the treatment of the above conditions and finally to recommend the routine use of L-epinephrine at the dose of 0.1ml/kg as protocole for the management croup and (UAO) post bronchoscopy in Children Material and Methods Between April1998 and April 2002, 120 children, who developed signs and symptoms of upper airway obstruction (UAO) after bronchoscopy such as severe irritative cough, wheezy chest, stridor and hoarseness of voice were randomized to receive either 0.1 mL/kg or 0.5 mL/kg of nebulized L-epinephrine (NLE) with maximum of 2mL for patients below 5 years of age and 4mL for patients above 5 years of age. Two mL of normal saline were added to the dose of L-epinephrine. Age group ranged from 4months to 14 years, mean of 4.6 years, male /female ratio 4:1. We used L-epinephrine because racemic epinephrine in not available in our hospital and it is expensive. The treatment was accomplished in the recovery room under the care of the anesthetist and pediatric surgeon using facemask with 100% oxygen at 6 liters/minute. The main parameter that evaluated was the change of the (UAO) scores (Table 1) and the other parameters that evaluated were changes in the respiratory rate, heart rate, blood pressure and oxygen saturation observed by pulse oxymeter. All parameters were evaluated at 15 minutes, 35 minutes and 45 minutes after the treatment, side effects of nebulized epinephrine, if present such as tremor, arrhythmia, and pallor were recorded at the same time. The management was repeated after 2 hours whenever clinically indicated if the results were not satisfactory. All patients were reviewed carefully prior to discharge from recovery room. RESULTS One hundred and twenty children post bronchoscopy for foreign body aspiration (FBA) were enrolled in this study. Sixty children were allocated to the 0.1mg/kg (NLE) and sixty children to the 0.5 mL/kg (NLE). The (NLE) was mixed with 2ml of normal saline. Both groups had the same baseline characteristics (Table 2) and both groups had initially moderate upper airway obstruction. Both groups showed clinically significant improvements and reduction in UAO scores and Oxygen saturation at 15, 35 and 45 minutes(Table 3) compared to that prior to (NLE) at time 0. There were no significant differences in UAO scores and VS between the groups at all time points and none required immediate intubation or re-bronchoscopy. Side effects of epinephrine including pallor, arrhythmia and tremor were not observed. Table 1: Upper airway obstruction score (15)** Score 0 1 2 Cough Stridor Retraction Inspiratory breath sounds Cyanosis* None None None Normal None Hoarse cry Inspiratory Suprasternal Harsh with rhonchi In room air Bark Inspiratory +expiratory Suprasternal+ substernal +intercostal Delayed In 40% oxygen *Cyanosis was modified and defined as oxygen saturation ** Downes JJ, Raphaely RC. Pediatric intensive care. Anesthesiology 1975; 43: 238-50. Table 2: Patient characteristics of our study groups 0.1mL/kg 0.5mL/kg Number of patients 60 60 Mean age (years) 3.4 5.8 Gender (M/F ratio) 4:1 4:1 UAO score immediately after bronchoscopy ( Mild ( Moderate 4-7) n, % (Severe > 7) n, % 12 (20%) 42 (70%) 6 (10%) 15 (25%) 38 (63.33%) 7 (11.66%) Table 3: The outcome variables in our study groups Time Time 0 15 Minutes 35 Minutes Nebulized L-epinephrine / Dose Number of patients 0.1mL/kg 0.5mL/kg 60 60 0.1mL/kg 0.5mL/kg 60 60 0.1mL/kg 0.5mL/kg 60 60 Upper airway obstruction score (Mean) 5 (1-8) 5 (1-7) 3 (1-6) 2 (0-5) 2 (0-5) 1.4 (0-5) Respiratory rate/minute (Mean) 28 30 32 33 29 28 Heart rate /minute (Mean) 126 128 130 128 125 123 Systolic blood pressure :mmHg (Mean) 95 100 102 106 97 103 Diastolic blood pressure: mmHg (Mean) 55 61 58 63 56 62 Oxygen saturation % (Mean) 93 94 96 97 98 98 Discussion Post bronchoscopy croup and respiratory distress is know entity in pediatric age group, especially when there is a need for repeated bronchoscopic trials for retrieval of long standing foreign bodies. In such conditions, severe inflammatory process of tracheo-bronchial tree is almost present from certain foreign bodies like peanut and other seeds that elaborate severe irritative substances leading to infection and granulation of bronchial tree that aggravate the respiratory distress, bronchospasm and croup post bronchoscopy. The main aim of the clinician in such conditions is to provide relief of respiratory distress by decreasing upper airway irritation and improving air entry. The present study has attempted to verify the safety and efficacy of bronchodilator effect of (NLE) and to prove that a dose of 0.1mL/kg is at least as effective as the dose of 0.5mL/kg in the treatment of croup and (UAO) post bronchoscopy in children. Many studies have tested the value of racemic epinephrine compared to placebo (10) and to nebulized salbutamol (11-13) and the results showed superior value of racemic epinephrine in the treatment of bronchiolitis. It seems no pharmacological basis for the belief that racemic epinephrine is safer than L-epinephrine (3-5) and racemic epinephrine is not available in Jordan and is thus difficult to obtain and expensive, making L-epinephrine a more viable option. Sumboonnanonda (14) used (NLE) at the dose 0.05mL/kg (maximum 0.5mL) in the treatment of infectious croup. They found a clinically significant improvement in (UAO) scores at 24 and 48 hours after admission, even in the placebo group without dexamethasone treatment .The present study found similar results at average 30 minutes in children with post-bronchoscopy croup and wheezy chest. The maximum dose of (NLE) in this study was 2mL for patients less than 5 years of age and 4mL for patients more than 5 years. In our study we confirmed the safety and efficacy of (NLE) in the treatment o f post intubation croup (6) and infectious croup (7), when Nutman (6) used 0.25mL of 1% L-epinephrine (2.5mg) regardless the weight, for children post-intubation croup and found significant reduction of stridor score within 20 minutes, the same we observed in our study which continued at least over the next 4 hours post –bronchoscopy. Waisman (7) used 5mL of 1/1000 L-epinephrine (5mg), regardless the weight, in children with infectious croup when he found a significant reduction of croup score, reaching its maximum at 30 minutes. The majority of our patients required one section of (NLE) to achieve these results and in very few of them who had long standing foreign bodies and repeated trials of bronchoscopy and bronchial wash out, another session of (NLE) required over 24 hours on 6 hourly interval. The present results suggest that nebulized L-epinephrine, at a minimal dose of 0.1 mL/kg, is at least as effective as the dose of 0.5 mL/kg in the treatment of post-bronchoscopy c roup. Both doses temporarily alleviated airway obstruction without undesirable side effects. The dose of 0.1 mL/kg is much less expensive. We would suggest that the dose of 0.1 mL/kg is also efficacious in the treatment of children with post-bronchoscopy croup. This dose may be adequate to diminish mucosal edema of the upper airway by stimulating alpha-adrenergic receptors and producing vasoconstriction (4). In conclusion, the presented data suggest that administration (NLE), at the dose of 0.1 mL/kg is safe and effective and results in a similar reduction in upper airway obstruction scores, compared with the dose of 0.5 mL/kg, in children with post-bronchoscopy croup. Neither dose was associated with any adverse side effects and we recommend the routine use of 0.1mL/kg (NLE) post –bronchoscopy in children. Taking in consideration the comparable efficacy of both doses, the use of a small dose in clinical practice would save the medication expense and, theoretically, have a lower risk of developing side effects that are mostly dose dependent. Future studies should consider the use of (NLE) at the dose of 0.1 mL/kg in children with post bronchoscopy croup, which has a pathophysiology resembling infectious croup. Further studies examining the optimal dose and frequency of (NLE) in children with croup due to different pathologies including post-bronchoscopy croup seem warranted. Acknowledgment to DR Mohamad Al-Sukar, Chair of Anesthesia Department –Royal Medical Services,Dr Kassem Khamaeseh,MD, Anesthesia Intensive care for their support and review of this manuscript. References 1. Borland LM, Colligan J, Brandom B.W. J Clin Anesthesia Koba BV, Jeon IS, Andre JM, MacKay I, Smith RM. Postintubation croup in children. Anesth Analg 1977; 56:501-5 Holbrook PR, Issues in airway management -1988. 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