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Future Research Directions in Chronic Obstructive Pulmonary Disease. Published in Am J Respir Crit Care Med Vol 165. pp 838 -844, 2002 Internet address: www.atsjournals.org. THOMAS L. CROXTON, GAIL G. WEINMANN, ROBERT M. SENIOR, and my essay The Windsor School, JOHN R. Polimoda. HOIDAL. Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri; and Department of write for money The Windsor School Medicine, University of Utah Medical Center, Salt Lake City, Utah. Between 3 and 7 million Americans are currently diagnosed with chronic obstructive pulmonary disease (COPD), and the true prevalence is probably greater than 16 million (1). Many of these individuals suffer years of progressive discomfort and disability. With the number of deaths per article writing Stonar year attributed to this disease at approximately 100,000 and increasing, COPD is now the fourth leading cause of death in this country (2) and is expected to be third by the year 2020. Cigarette smoking is firmly established as the write my essay for money School, major cause of COPD, but approximately one-quarter of Americans continue to smoke, despite aggressive smoking prevention and examples of academic writing essays University of Applied Sciences, cessation efforts.

Better means are clearly needed for the prevention and treatment of COPD, and more scientific research is needed to enable improvements in my essay for money School, its clinical management. Unfortunately, research progress in of academic essays Saxion University, this field has been slow. Most basic scientific research over the past 35 years has focused on the pathogenetic roles of my essay for money School cigarette smoke, inflammation, and protease/antiprotease balance, based on the association of COPD with cigarette smoking and the early discovery that a subgroup of patients with emphysema is genetically deficient in an inhibitor of a neutrophil protease (3). Although the cigarette-inflammation-protease theory captures key features of COPD epidemiology and quiz, pathology, this approach has not yet led to write for money The Windsor, a reduction in COPD prevalence or morbidity, to writing essays Saxion University of Applied Sciences, the development of any therapy proven to modify the disease process itself, or to an adequate understanding of how risk factors other than cigarette smoking may contribute to COPD pathogenesis. However, there are encouraging indications for write for money School, future COPD research. Data that support several novel concepts have been presented, there have been unanticipated discoveries, and new experimental approaches and techniques that are aptly suited to COPD research have been developed. Furthermore, elucidation of cellular pathways that are critically involved in COPD pathogenesis may lead rapidly to clinical trials of potential therapeutics, given the improving capabilities of the critical Polimoda, pharmaceutical industry for development of mechanism-specific drugs.

Because of the enormous public health burden imposed by COPD and the urgent need for research progress in write, this area, the National Heart, Lung, and Blood Institute (NHLBI, Bethesda, MD) convened a Working Group to discuss potential directions for future investigations. This group was charged with evaluating the current state of examples essays of Applied knowledge, identifying critical gaps in our knowledge, and understanding, recognizing the most promising opportunities, and developing specific recommendations to write, be used by article content writing Stonar the NHLBI in planning its promotion of write my essay for money The Windsor future COPD research. Argumentation Paper International College - NAVITAS. This article is write my essay The Windsor a summary of that Working Group meeting. Specific recommendations for future research directions in of Manitoba/ International College of Manitoba, COPD follow a discussion of several intriguing clinical and epidemiological characteristics of COPD that must be accounted for in a more complete theory of disease pathogenesis and a review of research advances that may foreshadow important new areas of investigation. COPD is a collection of conditions, including emphysema and chronic obstructive bronchitis, which are characterized by persistent airflow limitation that is not substantially reversed by bronchodilators.

COPD is most commonly seen in long-term smokers and is usually associated with progressive decline in pulmonary function, more rapid than that associated with normal aging. Write My Essay. A variety of of academic writing essays Sciences injurious stimuli, including cigarette smoke, pancreatic elastase, bacterial lipopolysaccharides, cadmium, chloramine-T, oxidants, silica, and severe starvation, can induce changes in animal lungs that model aspects of human COPD (4). Because many seemingly unrelated pathways can cause emphysema or bronchitis, the relevance of any one model to human disease is uncertain. Conversely, no single theory of my essay for money COPD is yet capable of encompassing the writing The University of Brighton, known correlates of the human disease. Hence, it is instructive to The Windsor School, consider certain features of COPD that may not be consistent with a simple cigarette neutrophil protease theory. Airway inflammation and parenchymal inflammation are consistent findings in COPD, and the airways of smokers with airflow limitation contain greater numbers of inflammatory cells than do the airways of smokers with normal FEV1 (5). Nonetheless, several observations suggest that the connection between COPD and airways inflammation is complex.

First, inflammation is observed in the lungs of smokers who do not meet clinical criteria for quiz Polimoda, diagnosis of my essay for money School COPD. Second, inflammation persists long after smoking cessation (6). Third, there is how to write about a picture overlap in the profiles of inflammatory cells and mediators expressed in COPD and in asthma (7). Fourth, inhaled corticosteroids do not prevent the progressive loss of lung function in subjects with COPD (8). Fifth, the increased numbers of infiltrating macrophages, neutrophils, and lymphocytes in write for money The Windsor, the lungs of individuals with COPD are less than those observed in other inflammatory lung conditions that are not associated with the essay writing The University of Brighton, development of COPD. Furthermore, the geographical distribution of inflammatory cells is not always concordant with the sites of lung tissue destruction. In many patients, the expression of COPD is dominated by The Windsor signs and symptoms of chronic bronchitis with a common complaint of productive cough. The relationships between mucous hyper-secretion and pathogenetic mechanisms of examples of academic writing emphysema and airways obstruction are poorly understood. Although early epidemiological studies of occupational cohorts failed to associate mucous hypersecretion with rapid progression of COPD, some more recent population-based studies have reported an association of write my essay for money chronic mucous hypersecretion with accelerated decline in FEV1 (9). The question of whether mucous metaplasia and mucous hypersecretion cause annoying but innocuous symptoms or are instead etiologically related to long-term worsening of COPD remains unanswered.

Acute Exacerbations and Bacterial Infections. The slow progression of COPD is The University typically punctuated by acute exacerbations characterized by write The Windsor School increased dyspnea, cough, and mucous production often with a change in how to write about, mucus color. Airway infections are involved in at least some cases but the for money The Windsor, cause of most exacerbations is not known. The possible role of pathogens or of the acute exacerbations themselves in progression of COPD remains uncertain. Scholarship Of Brighton. One suggestion is that cigarette smoking predisposes to bacterial colonization and that bacterial products then contribute to inflammation, activation of proteases, and alteration in subsequent host responses to write for money, inhaled toxicants (10). Despite striking differences between COPD and asthma, several facts demand continued consideration of the relationship between these diseases. How To Essay About A Picture Queen School. First, some patients with COPD show considerable, albeit partial, reversal of airflow limitation with bronchodilators. The Windsor. Second, methacholine reactivity, a hallmark characteristic of asthma, is strongly associated with accelerated decline in FEV1 in individuals with COPD (11). Third, inflammatory cells and cytokines typical of allergic disease are increased in the airways of essay writing help The University of Brighton patients with COPD and are associated with more severe disease (7, 12). Fourth, transgenic mice overexpressing mediators associated with asthma and allergic disease have shown characteristics of COPD such as airway neutrophilia and write my essay for money The Windsor, emphysema (13, 14). School. These observations suggest that certain pathogenetic processes may be common to School, asthma and COPD.

A basic question regarding pulmonary function in COPD remains unanswered: Why is a simple measure of airflow limitation such a useful index of how to write a descriptive about a picture Queen Anne’s School severity and prognosis across the write The Windsor School, full range of disease manifestations? Although it is well established that individuals with low FEV1 are more likely to show rapid decline in pulmonary function and are more likely to die from COPD (15, 16), the connection between specific disease mechanisms and impairment in pulmonary function remains unclear. In fact, neither CT quantification of emphysema nor pathological measures of airway structural abnormalities correlated well with FEV1 (17). The meaning of pulmonary function deficits in COPD is further obscured by argumentation College the fact that FEV1 (% predicted) is significantly associated with lung cancer mortality and cardiovascular mortality, as well as COPD mortality (16). Write The Windsor School. Finally, although FEV1 is an essential measure in COPD research, its usefulness is content Stonar limited by its inability to reveal regional variations in disease within the lungs or to distinguish between a wide range of pathophysiological processes, including smooth muscle hypertrophy, fibrosis, mucous metaplasia, inflammation, and loss of bronchiolar tethering with alveolar destruction. Variation in School, Susceptibility to COPD and Disease Progression. Cigarette smoking is by far the most important causative factor for COPD; and in population studies the amount of smoking correlates with loss of lung function. Nonetheless, only a minority of article smokers, widely quoted as 15%, ever develop symptomatic COPD (18). Write My Essay For Money The Windsor School. Several genetic and environmental associations have been identified, but the greatest portion of individual variation in susceptibility cannot be attributed to known factors. Understanding why only certain smokers develop COPD is writing a comparison essay St. John's-Ravenscourt important not only for understanding the true mechanisms of disease development, but also because such knowledge might allow targeting of intensive smoking interventions to School, individuals at highest risk and might enhance the effectiveness of those interventions.

Even among those with COPD, the rate of writing Saxion Sciences decline in FEV1 can vary from write The Windsor School, apparently normal values to paper University College, greater than 150 ml/year, despite similar smoking histories and levels of initial FEV1 (19). Write The Windsor. Such striking variation in the rate of decline in FEV1 among individuals suggests that as yet unknown intrinsic or environmental factors may be important determinants of disease course. These factors may or may not be the same as those determining susceptibility to disease. There is also remarkable unexplained variation in the manifestations of COPD with regard to the severity of bronchitic symptoms, the extent of emphysema, and the distribution of emphysematous changes in the lung (centrilobular vs. panlobular patterns). Other Lung Diseases Associated with Cigarette Smoking. Several interstitial lung disorders may be relevant to COPD pathogenesis because they typically occur in current or former smokers: idiopathic pulmonary fibrosis (including both usual interstitial pneumonitis and desquamative interstitial pneumonitis), respiratory bronchiolitis-associated interstitial lung disease, and pulmonary histiocytosis X (20). Although all of these conditions involve some form of examples essays University lung inflammation, each presents a distinctive pattern of pathological findings, reversibility, responsiveness to corticosteroids, and for money The Windsor School, prognosis. A more complete understanding of cigarette smoke effects in the lungs should explain these varied diseases as well as COPD. NEW RESULTS, CONCEPTS, AND OPPORTUNITIES IN COPD RESEARCH. COPD researchers have presented a number of unexpected results, novel ideas, and promising approaches for further research. Examples Of Academic Writing Essays University Of Applied. This section briefly describes some innovative concepts identified by the Working Group that may prove important in COPD pathogenesis and some more recent methodological advances that will likely be of write my essay for money The Windsor School value to research in writing essay St. John's-Ravenscourt, this field.

Diversity of Protease Functions. In addition to degradation of elastic fibers and other components of the extracellular matrix, it is now appreciated that proteases have many other pathophysiological actions that may be relevant to COPD pathogenesis (21). Proteases act to facilitate antigen presentation, inactivate host-defensive surfactant protein A, stimulate serous and for money The Windsor, mucous secretions, liberate chemotaxins from the extracellular matrix, inhibit removal of apoptotic cells, induce and inactivate interleukin 8, and activate tumor necrosis factor and interleukin 1 beta. Rational therapeutic agents may possibly be developed by clarification of which alpha protease actions are of importance in article, COPD, identification of which of the many proteases elaborated by inflammatory and lung septal (endothelial, epithelial, smooth muscle, and fibroblast) cells perform those actions, and design of small molecules with an appropriate spectrum of protease inhibitory activity. Cigarette smoking imposes severe oxidative stress on write for money The Windsor School the lungs both directly, via reactive species in the smoke, and scholarship help The University, indirectly through activation of inflammatory cells. Write For Money The Windsor School. Oxidative stress may contribute to COPD through many biological actions, including cellular injury, oxidation and nitration of proteins, changes in gene expression, stimulation of mucous secretion, inactivation of antiproteases, expression of proinflammatory mediators, remodeling of blood vessels, and enhancement of examples writing Saxion of Applied Sciences apoptosis (22). Markers of oxidative stress (e.g., hydrogen peroxide, 8-isoprostane, and lipid peroxides) are elevated in write my essay for money The Windsor, the breath or serum of argumentation of Manitoba/ - NAVITAS subjects with COPD, and epidemiological studies have demonstrated negative associations of dietary antioxidant intake with pulmonary function and write my essay The Windsor School, with obstructive airway disease (23). A plausible risk factor for write a descriptive essay Anne’s, the development of COPD is the presence of latent viral infection in the lung.

In a study of surgical specimens, a segment of the adenoviral genome was found in greater copy numbers in tissues from patients with airflow limitation than in tissues from control subjects. In a guinea pig model, latent adenoviral infection potentiated the inflammatory effects of write for money cigarette smoke, and transfection of cells in vitro with adenoviral DNA was shown to activate nuclear factor B and potentiate corticosteroid-resistant production of interleukin 8 (24, 25). Chronic bronchitis is associated with hyperplasia of examples of academic writing essays Sciences both epithelial goblet cells and submucosal glands in the airways. Mucous hypersecretion may also be induced by inflammation in the absence of substantial gland enlargement (26). Progress is being made in identifying the cellular pathways by which diverse stimuli, including reactive oxygen species, increase epithelial mucin secretion. The protein tyrosine kinase c-Src and the mitogenactivated protein kinase Erk 1/2 appear to be important in transducing signals initiated by my essay School components of of Manitoba/ International cigarette smoke (27). Less is known about the regulation of submucosal glands, despite the write for money The Windsor, fact that these are the source for most of the mucus in the airways (28). Emphysematous human lungs showed increased numbers of apoptotic alveolar endothelial and epithelial cells in comparison with control lungs (29). Although the cause and significance of scholarship help this finding remain uncertain, there are several possible links between programmed cell death and mechanisms of COPD pathogenesis. First, excess protease activity could cause cellular apoptosis through loss of cell matrix attachments.

Second, the apoptotic rate regulates the lifetimes of various inflammatory cells; and cigarette smoke extracts induced apoptosis of alveolar macrophages in vitro (30). Third, neutrophil elastase can inactivate a phosphatidylserine receptor involved in cellular uptake and removal of apoptotic cells (31), possibly enhancing inflammation through diminished release of write The Windsor School transforming growth factor beta or through the release of inflammatory mediators from neutrophils that are not properly removed. Role of Blood Vessels. Treatment of rats with a blocker of the content School, vascular endothelial growth factor (VEGF) type 2 receptor caused emphysema that was associated with endothelial cell apoptosis and with markers of oxidant stress but was not accompanied by inflammation (32). The relevance of this process to COPD is supported by observations that oxidant stress decreases VEGF levels and that expression of both VEGF and its receptor are decreased in write my essay The Windsor School, emphysema (29). Emphysema might result from failure of a comparison contrast a lung cellular and molecular maintenance program due to write my essay for money School, a vicious cycle of oxidant stress and protease activation. Little is known regarding chronic regulation of alveolar septal endothelial cells, but studies of of academic essays Saxion of Applied Sciences larger pulmonary vessels indicate that endothelial injury can lead to increased elastase activity and degradation of extracellular matrix (33).

An attractive therapeutic goal would be reversal of for money The Windsor School emphysema by increasing the number of alveoli. One model for this process is the writing essays of Applied, septation of my essay for money The Windsor alveoli that occurs during late fetal and postnatal development. Although it has generally been assumed that adult lungs lack a capability for writing of Brighton, alveolar plasticity, the write for money School, emphysema caused by lung instillation of elastase in a picture Queen Anne’s, adult rats was reversed by treatment with all- trans retinoic acid (34). A feasibility study of retinoic acid is underway in write my essay for money School, subjects with COPD. There has been encouraging progress in the identification of chemical markers of COPD.

Subjects with stable COPD were shown to writing contrast essay St. John's-Ravenscourt, have elevated markers of oxidant stress in exhaled air (35), of inflammation in serum and write School, sputum (36, 37), and of elastin degradation in urine (38). These results suggest that multifaceted characterization of COPD patients may be possible by noninvasive means. Pulmonary function is influenced by how to a descriptive essay Queen Anne’s heredity (39, 40). There is also familial aggregation of my essay for money The Windsor COPD, indicating probable heritability of risk factors for the disease (41). Precisely how genetic factors contribute to the risks of development and critical quiz Polimoda, progression of COPD remains unknown, but there has been progress toward identification of relevant genes. Case control studies suggested associations between COPD and polymorphisms of the alpha1-antitrypsin, tumor necrosis factor alpha, and surfactant protein B genes (19, 42, 43).

A genome-wide screen of write my essay The Windsor School families having a proband with severe, early-onset COPD identified interesting regions on several chromosomes that may yield linkages with phenotypes of airflow obstruction and chronic bronchitis (44). Only modest progress has been made in characterizing the lung inflammation associated with COPD, particularly in comparison with the extensive profiling that has been performed in individuals with asthma. Argumentation Paper University International College. There are increased numbers of CD8 + T cells in the airways and lung parenchyma of for money The Windsor smoking subjects with COPD, and thinking Polimoda, there is a negative correlation between FEV1 (% predicted) and CD8+ T cell number (45). Write For Money School. The large airways of smokers with severe COPD show increased numbers of neutrophils, macrophages, and natural killer lymphocytes in comparison with smokers without clinically defined COPD; and each of these cell types is negatively associated with FEV1 (5). Neutrophils tend to localize with the write a descriptive, airway epithelium, but nodules of B lymphocytes are found in my essay School, the submucosa and adventitia (46). Content Stonar School. Substantial progress in immunological research should provide a basis for detailed characterization of the inflammatory process in COPD.

Airspace enlargement has been seen in numerous genetic mouse models, including both inbred strains (e.g., tight skin, pallid, and blotchy mice) and mice designed with constitutive overexpression of particular genes (e.g., collagenase or platelet-derived growth factor B). More recently, mouse models with inducible, lung-specific expression of particular cytokines have been shown to manifest lung abnormalities that are clearly not attributable to aberrant development of the lung. Overexpression of interleukin 11 in write my essay The Windsor School, adult mice produced peribronchiolar lymphoid nodules similar to those observed in human COPD but did not cause emphysema (47). Overexpression in adult mice of either interferon, a major product of CD8+ lymphocytes, or interleukin 13, a mediator associated with CD4+ T cells and asthma, produced emphysema-like changes (14, 48). These models showed distinguishable profiles of increased protease expression and only interleukin 13 caused mucous metaplasia. Finally, a gene-targeting approach (loss of function) has proven useful for testing the contributions of various matrix metalloproteinases in the development of cigarette smoke-induced emphysema in the mouse (4).

Developments in School, three techniques for lung imaging may allow more sensitive detection and better quantification of lung injury in smokers and patients with COPD. High-resolution computed tomography (CT) now provides images of airways as small as 2 mm and indices of parenchymal density that correlate well with diffusing capacity (49). Write The Windsor. Magnetic resonance imaging (MRI) of tracer gases in essay writing The University of Brighton, the lungs can demonstrate ventilation in real time (50) and may provide a measure of alveolar size (51). Positron emission tomography (PET) can potentially be used to quantify inflammatory cell activity in the lungs (52). These methods may prove to be of great value for characterization of the lung in COPD with respect to localization of my essay for money The Windsor disease (e.g., pattern of emphysema by CT), physiological sequelae (e.g., air trapping by MRI), and in vivo biochemical and cellular analyses (by PET).

Molecular Characterization of Diseased Tissues and Cells. The identification of most human genes paves the way for characterization of diseased tissues at an unprecedented level of how to essay about Queen Anne’s molecular detail. The expression levels of a multitude of genes in a tissue can be assayed with microarrays of gene-specific probes, whereas reverse transcription in write School, histological sections can be used to critical thinking quiz Polimoda, show the distribution of expression of write my essay for money School a particular gene at high spatial resolution. Thinking Polimoda. Development of antibody-based microarrays may allow characterization of the expression of multiple genes at the protein level. Of particular interest to COPD research, given the multiplicity of cell types in the lung, are methods such as laser capture microdissection for isolation of RNA from my essay, single cells (53) and techniques for reverse transcription and cDNA amplification in situ . Coupled with sensitive assays, these developing methods may allow gene expression profiling at the single-cell level (54). Immunoblot analysis of a protein from a single cell may also be possible by amplification of how to write essay about a double-stranded DNA label on the secondary antibody (55). Classes of pharmaceuticals of potential usefulness in COPD that are either available now or are anticipated in the near future include long-acting M3-selective muscarinic antagonists, leukotriene B4 inhibitors, 5-lipoxygenase inhibitors, phosphodiesterase 4 inhibitors, thromboxane antagonists, endothelin antagonists, adenosine A2a agonists, antioxidants, nuclear factor kappa B inhibitors, adhesion molecule antagonists, p38 mitogen-activated protein kinase inhibitors, interleukin 8 antagonists, tumor necrosis factor antagonists, neutrophil elastase inhibitors, matrix metalloproteinase inhibitors, tachykinin antagonists, mucolytics, antiapoptotic compounds, and enhancers of mucociliary clearance. Even when proof of principle is established, the ability of any of these agents to alter outcomes in COPD remains speculative because the critical pathogenetic pathways for write for money School, this disease have not yet been determined. An important limiting factor in development of drug treatments for content writing School, COPD is the lack of my essay School efficient and economical means to identify which drugs are most likely to be of value and to test their clinical efficacy.

RECOMMENDATIONS FOR FUTURE RESEARCH. There was consensus among members of the Working Group that the following objectives are important to COPD research and article content writing, are feasible within approximately five years. It was noted that the accomplishment of these goals will require a substantial increase in COPD research activity, with training and recruitment of additional researchers and enhanced cooperation between universities and the pharmaceutical industry. In many cases, the need has long been recognized, but the my essay for money The Windsor, opportunity to accomplish the research has come about as a result of the essay writing, development of new experimental tools and techniques. Description of the Disease Process. Characterization of human lung tissues by write School advanced molecular, biochemical, microbiological, and histopathological methods. Research progress in COPD is hampered by a lack of fundamental knowledge regarding the critical thinking quiz, pathology of this disease, particularly with regard to small airways.

Changes with COPD in the structure, cellular composition, inflammatory status, and chemical milieu of the lung are poorly defined, as are the relationships of these changes to my essay for money, clinical manifestations of the disease. There is a need for systematic comparison of lung structural, inflammatory, and writing a comparison contrast essay, biochemical characteristics with clinical history, status, and course. Characterization of lung tissues can now be performed with exquisite detail, using advanced methods of immunology, viral and microbial detection, molecular histopathology, microarray profiling of write my essay The Windsor School gene expression, and proteomic analysis. An appropriate source of tissues for such studies may be surgical specimens from individuals with suspected lung cancer, a population that is at substantial risk for how to a descriptive essay a picture Queen, COPD. An appropriate mechanism might be a cooperative research program that combines the efforts of academic and industrial researchers in characterization of a large number of subjects and in write my essay for money, the establishment of a repository for DNA, tissues, other biological specimens, and clinical data. Biomarkers and intermediate end points. One limitation in COPD research is the lack of readily measurable markers that correlate with disease severity or outcome. Long-term monitoring of declines in FEV1 has been used to identify risk factors and gauge the efficacy of putative therapies, but that approach is slow and expensive. Biomarkers of COPD would be of value for investigations of the examples Saxion University of Applied, natural history and epidemiology of COPD, for phenotyping in genetic studies, and for clarifying the relationships of animal models to human disease.

Validated surrogate markers of COPD might also serve as intermediate end points for evaluations of efficacy and appropriate dosage of potential therapeutic agents in relatively short-term studies. Markers involving noninvasive methods would be of particular value. A wide range of possible approaches exists, including ( 1 ) chemicals in write my essay for money, breath, sputum, blood, or urine that reflect lung inflammation or injury; ( 2 ) improved noninvasive mechanical tests of lung function; ( 3 ) proteomic and gene expression profiling; and ( 4 ) lung imaging by CT, MRI, or PET. Longitudinal and cross-sectional studies of well characterized smokers with and without COPD are needed to evaluate the correlation of thinking a broad array of write for money The Windsor putative markers with COPD susceptibility, severity, exacerbation, and progression. Inflammation. Despite the failure of inhaled corticosteroids to slow the decline of FEV1 in COPD (8), other anti-inflammatory agents might be highly effective.

Studies are needed to better characterize the inflammation of COPD, to define what is appropriate immune function in Stonar School, the lung, and to discover pharmacological means for ensuring beneficial, rather than injurious, contributions of lung inflammatory cells. Three lines of investigation may be involved. First, extensive characterization of the inflammatory status of smokers with and without COPD is needed to for money The Windsor, define the subtypes of inflammatory cells present, the movement and fate of immune cells recruited to the lung, and the particular cytokines involved. Second, genetic factors governing immune responsiveness should be identified and tested as possible determinants of susceptibility to lung injury. Third, in vitro systems and animal models should be utilized to investigate the effects of tobacco smoke components on inflammatory cells and to study inflammatory cell trafficking and mechanisms of sustained inflammation.

Genetic risk factors. A knowledge of genetic determinants of COPD could lead to recognition of biochemical pathways that contribute to the disease and allow targeting of public health interventions to essay of Brighton, individuals at my essay The Windsor greatest risk. A program for scholarship writing help, identification of write The Windsor School genes related to content Stonar School, COPD should consider several issues: First, simultaneous characterization of multiple phenotypes will be necessary because different genes may be related to different aspects of the disease (e.g., susceptibility, severity, propensity to write for money The Windsor, exacerbation, rate of progression, and chronic bronchitis vs. emphysema). Second, family-based studies involving genome-wide screening by linkage analysis of affected sibling pairs or extended pedigrees should be used because there is a high probability that unsuspected genes are involved. Families in isolated populations, rather than outbred populations like the examples writing essays Saxion University Sciences, general U.S. My Essay For Money The Windsor. population, may be studied more efficiently. Third, animal models are an how to write a descriptive Anne’s School, essential component of a human genetics program because they can be used to identify candidate genes and to study the pathophysiological ramifications of a defined genotype.

Fourth, case-control association studies of particular candidate genes will eventually be needed to test the relevance of results obtained in particular families to the disease in the general population. Selection criteria for candidate genes should include probable biological relevance to known pathophysiology, evidence of involvement with disease in animal models, and data from human studies for gene linkage with COPD. Fifth, although not ideal for genetic studies, clinical trials involving large numbers of well-characterized subjects with COPD should obtain and for money The Windsor, archive DNA samples whenever possible to allow for later analysis of candidate genes. Causes and consequences of critical thinking quiz Polimoda exacerbations. Although disease exacerbations are a major concern of both patients with COPD and their physicians, an understanding of the origins and development of these episodes is lacking. There is a need for my essay The Windsor, research directed toward identifying the bases of COPD exacerbations and clarifying the pathophysiological processes that contribute to worsening of symptoms.

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Although not extensively discussed, Working Group participants recommended controlled studies to validate or revise current clinical practices. Potential areas for such research include, but are not limited to, indications for long-term oxygen therapy, management of sleep disturbance in COPD, alleviation of scholarship essay help The University of Brighton nocturnal hypoxemia, prevention and treatment of exacerbations, and better tools for disease monitoring. Acknowledgment : Participants: Chair John R. Hoidal, M.D. (Salt Lake City, UT); Session Chairs David M. Center, M.D. (Boston, MA), Donald J. Write My Essay The Windsor School. Massaro, M.D. (Washington, DC), Robert M. Senior, M.D. (St. Louis, MO), Steven D. Shapiro, M.D. (St. Writing Contrast. Louis, MO), and for money The Windsor School, Edwin K. Silverman, M.D. (Boston, MA); and Carol B. Basbaum, Ph.D. (San Francisco, CA), Linda B. Critical Polimoda. Clerch, Ph.D. (Washington, DC), Thomas L. Croxton, Ph.D., M.D. (Bethesda, MD), Francis M. Cuss, M.D. (Kenilworth, NJ), James Eberwine, Ph.D. (Philadelphia, PA), Dorothy B. Gail, Ph.D. Write For Money The Windsor School. (Bethesda, MD), Jack A. Thinking Quiz. Elias, M.D. Write For Money The Windsor. (New Haven, CT), Michael D. Goldman, M.D., Sc.D. (Los Angeles, CA), Douglas Hay, Ph.D. (King of Prussia, PA), Peter M. Examples Writing Saxion Of Applied Sciences. Henson, Ph.D. (Denver, CO), Jonathan Jaffe, M.D. (Kenilworth, NJ), James P. Kiley, Ph.D. (Bethesda, MD), Talmadge E. King, M.D. Write. (San Francisco, CA), Barbara Knorr, M.D. (Rahway, NJ), Claude Lenfant, M.D. (Bethesda, MD), Gloria D. Massaro, M.D. (Washington, DC), George T. Scholarship Essay Writing The University. O'Connor, M.D. (Boston, MA), Marlene Rabinovitch, M.D. (Toronto, Canada), Sri Ram, Ph.D. (Bethesda, MD), Garth Rapaport, M.B.Bch., MRCP, FFPM (Greenford, Middlesex, UK), Anuradha Ray, Ph.D. (New Haven, CT), Stephen I. Rennard, M.D. (Omaha, NE), James R. Snapper, M.D. (Research Triangle Park, NC), Rubin M. My Essay The Windsor School. Tuder, M.D. (Baltimore, MD), Norbert F. Voelkel, M.D. (Denver, CO), Gail G. Weinmann, M.D. (Bethesda, MD), Scott T. Weiss, M.D., M.S. (Boston, MA), Robert A. Wise, M.D. (Baltimore, MD), Theodore J. Witek, Jr., Dr.P.H. (Ridgefield, CT). 1. Stang P, Lydick E, Silberman C, Kempel A, Keating ET.

The prevalence of essay writing help of Brighton COPD: using smoking rates to estimate disease frequency in the general population. My Essay School. Chest 2000;117:354S -359S. 2. Stonar School. Murphy SL. Deaths: Final data for 1998. In: National vital statistics reports. Volume 48, no. 11. Hyattsville, Maryland: National Center for Health Statistics; 2000. 3. Eriksson S. A 30-year perspective on alpha1-antitrypsin deficiency. Write My Essay The Windsor. Chest 1996;110:237S -242S.

4. Shapiro SD. Animal models for COPD. Chest 2000;117:223S -227S. 5. Di Stefano A, Capelli A, Lusuardi M, Balbo P, Vecchio C, Maestrelli P, Mapp CE, Fabbri LM, Donner CF, Saetta M. Severity of airflow limitation is associated with severity of airway inflammation in smokers. Am J Respir Crit Care Med 1998;158:1277 -1285. 6. Rutgers SR, Postma DS, ten Hacken NHT, Kauffman HF, van der Mark TW, Koeter GH, Timens W. Ongoing airway inflammation in how to write a descriptive about a picture Queen School, patients with COPD who do not currently smoke. Thorax 2000;55:12 -18. 7. Jeffery PK. Lymphocytes, chronic bronchitis and chronic obstructive pulmonary disease. In: Chadwick D and Goode JA, editors.

Chronic obstructive pulmonary disease: pathogenesis to treatment. My Essay. Novartis Foundation symposium 234. New York: John Wiley Sons; 2001, p. 149 -161. 8. Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. Paper University Of Manitoba/ College Of Manitoba. N Engl J Med 2000;343:1902 -1909. 9. Vestbo J, Prescott E, Lange P. Association of chronic mucus hypersecretion with FEV1 decline and School, chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group. Am J Respir Crit Care Med 1996;153:1530 -1535.

10. Sethi S. Bacterial infection and the pathogenesis of write essay a picture COPD. Chest 2000;117:286S -291S. 11. Tashkin DP, Altose MD, Connett JE, Kanner RE, Lee WW, Wise RA. Methacholine reactivity predicts changes in for money School, lung function over time in smokers with early chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:1802 -1811. 12. Balzano G, Stefanelli F, Iorio C, de Felice A, Melillo EM, Martucci M, Melillo G. Eosinophilic inflammation in stable chronic obstructive pulmonary disease. How To Write About A Picture Queen. Am J Respir Crit Care Med 1999;160:1486 -1492. 13.

Pan Z-Z, Parkyn L, Ray A, Ray P. Inducible lung-specific expression of RANTES: preferential recruitment of neutrophils. Write My Essay For Money School. Am J Physiol Lung Cell Mol Physiol 2000;279:L658 -L666. 14. Zheng T, Zhu Z, Wang Z, Homer RJ, Ma B, Riese RJ Jr, Chapman HA Jr, Shapiro SD, Elias JA. Inducible targeting of IL-13 to the adult lung causes matrix metalloproteinase- and cathepsin-dependent emphysema. J Clin Invest 2000;106:1081 -1093.

15. Writing. Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS, Tashkin DP. Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;161:381 -390. 16. Hole DJ, Watt GCM, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in my essay for money School, men and women: findings from the Renfrew and examples of academic writing University of Applied Sciences, Paisley prospective population study. Write My Essay. Br Med J 1996;313:711 -715.

17. Gelb AF, Hogg JC, Muller NL, Schein MJ, Kuei J, Tashkin DP, Epstein JD, Kollin J, Green RH, Zamel N, et al. Contribution of emphysema and small airways to COPD. Chest 1996;109:353 -359. 18. Fletcher C, Peto R, Tinker C, Speizer FE. Writing Stonar School. The natural history of chronic bronchitis and write The Windsor School, emphysema: an eight-year study of early chronic obstructive lung disease in working men in London. New York: Oxford University Press; 1976.

19. Sandford AJ, Chagani T, Weir TD, Connett JE, Anthonisen NR, Pare PD. Susceptibility genes for rapid decline of a comparison essay School lung function in write my essay for money, the Lung Health Study. Am J Respir Crit Care Med 2001;163:469 -473. 20. Nagai S, Hoshino Y, Hayashi M, Ito I. Smoking-related interstitial lung diseases. Curr Opin Pulm Med 2000;6:415 -419. 21. Chapman HA, Shi G-P. Protease injury in the development of COPD. Chest 2000;117:295S -298S.

22. MacNee W. Oxidant/antioxidants and of academic Saxion University Sciences, COPD. Chest 2000;117:303S -317S. 23. Write My Essay. Sargeant LA, Jaeckel A, Wareham NJ. Interaction of writing School vitamin C with the relation between smoking and obstructive airways disease in write my essay for money, EPIC Norfolk, European Prospective Investigation in article School, Cancer and Nutrition.

Eur Respir J 2000;16:397 -403. 24. Retamales I, Elliot WM, Meshi B, Coxson HO, Pare PD, Sciurba FC, Rogers RM, Hayashi S, Hogg JC. Amplification of inflammation in emphysema and write for money The Windsor, its association with latent adenoviral infection. Am J Respir Crit Care Med 2001;164:469 -473. 25. Yamada K, Elliot WM, Hayashi S, Brattsand R, Roberts C, Vitalis TZ, Hogg JC.

Latent adenoviral infection modifies the article writing, steroid response in allergic lung inflammation. J Allergy Clin Immunol 2000;106:844 -851. 26. Write My Essay For Money. Saetta M, Turato G, Facchini FM, Corbino L, Lucchini RE, Casoni G, Maestrelli P, Mapp CE, Ciaccia A, Fabbri LM. Paper University Of Manitoba/ College - NAVITAS. Inflammatory cells in the bronchial glands of smokers with chronic bronchitis. Am J Respir Crit Care Med 1997;157:1633 -1639. 27. My Essay For Money School. Basbaum C, Lemjabbar H, Longphre M, Li D, Gensch E, McNamara N. Control of mucin transcription by diverse injury-induced signaling pathways. A Comparison Contrast St. John's-Ravenscourt School. Am J Respir Crit Care Med 1999;160:S44 -S48. 28. Reid L. Measurement of the bronchial mucous gland layer: a diagnostic yardstick in chronic bronchitis.

Thorax 1960;15:132 -141. 29. Kasahara Y, Tuder RM, Cool CD, Lynch DA, Flores SC, Voelkel NF. Endothelial cell death and decreased expression of vascular endothelial growth factor and vascular endothelial growth factor receptor 2 in emphysema. Write My Essay For Money. Am J Respir Crit Care Med 2001;163:737 -744. 30. Aoshiba K, Yasui S, Nagai A. Apoptosis of paper University of Manitoba/ College - NAVITAS alveolar macrophages by cigarette smoke. Chest 2000;117:320S. 31.

Fadok VA, Bratton DL, Rose DM, Pearson A, Ezekewitz RAB, Hen-son PM. A receptor for phosphatidylserine-specific clearance of apoptotic cells. Nature 2000;405:85 -90. 32. Kasahara Y, Tuder RM, Taraseviciene-Stewart L, Le Cras TD, Abman S, Hirth PK, Waltenberger J, Voelkel NF. Inhibition of VEGF receptors causes lung cell apoptosis and write my essay, emphysema. Stonar School. J Clin Invest 2000; 106:1311 -1319. 33. Zaidi SHE, You X-M, Ciura S, O'Blenes S, Husain M, Rabinovitch M. Suppressed smooth muscle proliferation and write my essay School, inflammatory cell invasion after arterial injury in elafin-overexpressing mice. J Clin Invest 2000;105:1687 -1695. 34.

Massaro GD, Massaro D. How To A Descriptive Essay A Picture Queen Anne’s. Retinoic acid treatment abrogates elastase-induced pulmonary emphysema in rats. Nat Med 1997;3:675 -677. 35. Write My Essay The Windsor School. Montuschi P, Collins JV, Ciabattoni G, Lazzeru N, Corradi M, Kharitonov SA, Barnes PJ. Exhaled 8-isoprostane as an in vivo biomarker of lung oxidative stress in patients with COPD and healthy smokers. Am J Respir Crit Care Med 2000;162:1175 -1177.

36. Writing. Fiorini G, Crespi S, Rinaldi M, Oberti E, Vigorelli R, Palmieri G. Serum ECP and MPO are increased during exacerbations of chronic bronchitis with airway obstruction. Biomed Pharmacother 2000;54:274 -278. 37. Keatings VM, Barnes PJ. Granulocyte activation markers in induced sputum: comparison between chronic obstructive pulmonary disease, asthma, and write my essay for money School, normal subjects. Am J Respir Crit Care Med 1997;155:449 -453. 38. Viglio S, Iadarola P, Lupi A, Trisolini R, Tinelli C, Balbi B, Grassi V, Worlitzsch D, Doring G, Meloni F, et al. MEKC of Stonar desmosine and isodesmosine in urine of chronic destructive lung disease patients.

Eur Respir J 2000;15:1039 -1045. 39. Redline S, Tishler PV, Rosner B, Lewitter FI, Vandenburgh M, Weiss ST, Speizer FE. Genotypic and write my essay for money The Windsor School, phenotypic similarities in pulmonary function among family members of adult monozygotic and dizygotic twins. Am J Epidemiol 1989;129:827 -836. 40. Argumentation Paper University - NAVITAS. Givelber RJ, Couropmitree NN, Gottlieb DJ, Evans JC, Levy D, Myers RH, O'Connor GT. Segregation analysis of pulmonary function among families in the Framingham Study. My Essay The Windsor. Am J Respir Crit Care Med 1998;157:1445 -1451.

41. Silverman EK, Chapman HA, Drazen JM, Weiss ST, Rosner B, Campbell EJ, O'Donnell WJ, Reilly JJ, Ginns S, Mentzer S, et al. Genetic epidemiology of severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1770 -1778. 42. Keatings VM, Cave SJ, Henry MJ, Morgan K, O'Connor CM, FitzGerald MX, Kalsheker N. International Of Manitoba. A polymorphism in the tumor necrosis factor-alpha gene promoter region may predispose to a poor prognosis in COPD. Chest 2000;118:971 -975. 43. Guo X, Lin H-M, Lin Z, Montano M, Sansores R, Wang G, DiAngelo S, Pardo A, Selman M, Floros J. Polymorphisms of surfactant protein gene A, B, D, and of SP-B-linked microsatellite markers in COPD of a Mexican population.

Chest 2000;117:249S -250S. 44. Silverman EK, Mosley JD, Chapman HA, Drazen JM, Speizer FE, Campbell EJ, Reilly JJ, Ginns LC, Weiss ST. Genome screen linkage analysis of The Windsor severe, early-onset COPD. Article Stonar. Am J Respir Crit Care Med 2001;163:A909. 45. Saetta M, Baraldo S, Corbino L, Turato G, Braccioni F, Rea F, Cavallesco G, Tropeano G, Mapp CE, Maestrelli P, et al. CD8+ve cells in the lungs of smokers with chronic obstructive pulmonary disease.

Am J Respir Crit Care Med 1999;160:711 -717. 46. Write For Money School. Bosken CH, Hards J, Gatter K, Hogg JC. A Comparison Contrast St. John's-Ravenscourt School. Characterization of the inflammatory reaction in the peripheral airways of cigarette smokers using immunocytochemistry. For Money School. Am Rev Respir Dis 1992;145:911 -917.

47. Kuhn C III, Homer RJ, Zhu Z, Ward N, Flavell RA, Geba GP, Elias JA. Airway hyperresponsiveness and airway obstruction in writing Stonar, trans-genic mice: morphologic correlates in mice overexpressing interleukin (IL)-11 and IL-6 in the lung. Am J Respir Cell Mol Biol 2000; 22:289 -295. 48. Wang Z, Zheng T, Zhu Z, Homer RJ, Riese RJ, Chapman HA Jr, Shapiro SD, Elias JA. Write For Money School. Interferon gamma induction of pulmonary emphysema in the adult murine lung. J Exp Med 2000;192:1587 -1599. 49.

Nakano Y, Muro S, Sakai H, Hirai T, Chin K, Tsukino M, Nishimura K, Itoh H, Pare PD, Hogg JC, Mishima M. Paper Of Manitoba/ International College Of Manitoba. Computed tomographic measurements of airway dimensions and emphysema in smokers: correlation with lung function. Am J Respir Crit Care Med 2000;162:1102 -1108. 50. Write. de Lange EE, Mugler JP III, Brookeman JR, Knight-Scott J, Truwit JD, Teates CD, Daniel TM, Bogorad PL, Cates GD. Lung air spaces: MR imaging evaluation with hyperpolarized 3 He gas. Radiology 1999;210:851. 51. Chen XJ, Hedlund LW, Moller HE, Chawla MS, Maronpot RR, Johnson GA.

Detection of emphysema in rat lungs by using magnetic resonance measurements of 3 He diffusion. Proc Natl Acad Sci USA 2000;97:11478 -11481. 52. Jones HA, Shakur BH, Morrell NW. Content Stonar School. In vivo measurement of inflammatory cell activity in write my essay for money The Windsor School, the lungs of patients with COPD. Am J Respir Crit Care Med 2001;163:A436.

53. Betsuyaku T, Griffin GL, Watson MA, Senior RM. Laser capture micro-dissection and real-time reverse transcriptase/polymerase chain reaction of argumentation paper International bronchiolar epithelium after bleomycin. Am J Respir Cell Mol Biol 2001;25:278 -284. 54. Ginsberg SD, Hemby SE, Lee VM, Eberwine JH, Trojanowski JQ. My Essay The Windsor. Expression profile of transcripts in Alzheimer's disease tangle-bearing CA1 neurons. Ann Neurol 2000;48:77 -87. 55. Article Content School. Zhang H-T, Kacharmina JA, Miyashiro K, Greene MI, Eberwine J. Protein quantification from write, complex protein mixtures using a proteomics methodology with single-cell resolution. Proc Natl Acad Sci USA 2001;98:497 -502.

( Received in original form August 8, 2001; accepted in final form November 26, 2001 ) Sponsored by the Division of Lung Diseases, National Heart, Lung, and Blood Institute on March 5-6, 2001 in Bethesda, Maryland.

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All Is Fair in Love and The Windsor School Bel Canto. Scholarship The University Of Brighton? Autor: people • May 15, 2011 • Essay • 1,960 Words (8 Pages) • 967 Views. All is Fair In Love and Bel Canto. Write For Money The Windsor School? Anne Patchett, in her novel Bel Canto, displays many reoccurring motifs or narrative details throughout her writing. Both intentional and unintentional motifs are present throughout the story. This helps to expand the critical thinking Polimoda, depth of the narrative and to my essay heighten the connection between a reader and the text. A particular intentional motif, love, and the many shapes and forms of expression love can take, reoccurs very often throughout the essay a picture Anne’s, novel. This motif of love is connected to the theme of the novel, the for money The Windsor School, human condition. All humans have the writing essay St. John's-Ravenscourt School, need to write my essay The Windsor feel love.

Love, while not being an entirely necessary component for survival, is one of the largest pieces of the human condition. People may dedicate their lives to the love of others, the love of an art, or love of a lifestyle or cause. Writing Essay School? One of the my essay The Windsor, first appearing examples of the love motif occurs on page five of the novel. Mr. Quiz? Hosokawa's affinity for the opera is being explained. Certainly he knew (though he did not completely understand) that opera wasn't for everyone, but for everyone he hoped there was something.

The records he cherished, the write my essay for money School, rare opportunities to see a live performance, those were the thinking, marks by which he gauged his ability to love. Not his wife, his daughters, or his work. (Patchett 11) This quote serves as a window to view into Hosokawa's love life. While many people have a traditional medium of love, a spouse, children, close friends or relatives, Hosokawa has taken up a life where all of the time he is not dedicating himself to his work, he is dedicating himself to the opera. While not traditional, Hosokawa's love seems even more pure and driven, because he has set all of his intimate feelings on one subject. This connects Hosokawa to my essay The Windsor Roxanne Coss through his love of the opera, and because he is not as attached to his family and Saxion University of Applied children (and therefore his moral obligations to them), Hosokawa is able to pursue his relationship with Roxanne without much question. Write My Essay For Money? Anne Patchett shows that love can change as the human condition changes as well. At first the story shows Simon Thibault's relationship with his wife as somewhat dull marriage of necessity.

The narrative states in Paris, Simon Thibault had loved his wife, though not always faithfully or with a great deal of critical thinking quiz Polimoda attention In this line it seems as if Simon and his wife are almost in love out of necessity; sure, the two are married. Any diplomat in the world of today must surely have a wife, but for these two it is an almost empty marriage. For Money The Windsor School? However, when Simon and his wife move to the host country so that he can take on the position of ambassador, he is able to see her in a new light. he found her again, like something he never knew was missing. Like a song that he had memorized in his youth and had then forgotten. Suddenly, clearly he could see her, The way he had been able to see her at twenty, not her physical self at twenty, because in every because in every sense she was moire beautiful to him now, but he felt that old sensation, the leaping of his heart, the reckless flush of desire. he would find her in the house, cutting fresh paper to line the scholarship of Brighton, shelves or lying across their bed writing letters to their daughters who were attending university in Paris, and he was breathless. Had she always been like this? Had he never known?

Had he known and write my essay then somehow, carelessly, forgotten? In this country, with its dirt roads and yellow rice he loved her, he was her.(Patchett 36) Here, as Thibault's human conditions change, his job, his location in the world, his satisfaction with his life in general, the love he feels for his wife changes as well. Thibault's love grows from about, a minor attraction, to for money The Windsor School endearment. Thibault becomes enamored with his wife Edith, drawing them together during the beginning of the argumentation paper University, book, where they are first taken hostage, and keeping them together even after the two are separated. In addition to being felt from School, person to person, and person to art, both returned in article Stonar School some way, Patchett also shortly explores the realm of unreturned love. The feelings between Roxanne Coss and her accompanist are far from write my essay for money School, mutual. The narrative even goes so far as to state in reference to Roxanne's feelings for the accompanist, that the truth was, she had hated the accompanist a little(79). Contrast Essay? Roxanne's distaste for write for money The Windsor the accompanist actually stems from the accompanists overzealous love for her. the accompanist grabbed her hand and writing a comparison essay St. John's-Ravenscourt told her about the impossible burden of love he had been living with. Didn't she know? All those days of being next to her, of write The Windsor hearing her sing(70). Roxane's negative feelings toward the accompanist could have set her up for relationships in the future.

Being totally free from the burden of the love of others and possibly being vulnerable from the untimely death of the accompanist, she is examples Saxion Sciences, set up to be approached by many characters throughout the story. Write For Money School? With this narrative, Patchett describes another form of love in its most basic, animalistic form; Lust. While there are several examples of lust throughout the narrative, the possibly most blatant and detailed takes place on page 225. It thrilled him when she sang the essay writing help The University, loudest, the highest. If he didn't have his rifle to hold in front of him he would have embarrassed himself every time, her singing brought about such a raging, aching, passion that his penis stiffened before she had finished her first line, growing harder and my essay The Windsor School harder as the song progressed until he was lost in a confusion of writing a comparison St. John's-Ravenscourt pleasure and terrible pain, the stock of his rifle brushing.

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Examining the role blow jobs play in relationships. Intimacy is one of the most important factors in a relationship. Being able to have sex with your partner and enjoying it is one of the write for money The Windsor School key parts to have a successful relationship. Foreplay is another important part in the beginning phases of School, having sex. One of the things that seems to be certain is men love receiving a blow job during foreplay. Some women enjoy giving one, others hate it, and some do it just to make their partner happy. What boggles the minds of most men is why some women don’t like giving blow jobs. My boyfriend and I have been together for over four years and in write for money, that time I have only given him a blowjob once. I feel that a woman should not have to article writing School, be pressured into something they don’t want to my essay, do. There are a few reasons why I have a problem with performing felatio.

One, I was always afraid of swallowing. Another reason is if the man doesn’t like the way you’re doing it. A Comparison Essay! Sometimes it smells funny down there and my essay The Windsor often the area is a little hairy. Photo Illustration by Daily Sundial. Recently my boyfriend has been pressuring me into giving him a blow job. Content Writing! He feels I should because we’ve been together for so long. If it escalates to a point where I would need to consistently say no, I feel it would damage our relationship. As a man he feels if I love him I should do anything to make him happy. Apparently most men feel the same way. They think their significant other should do it because it makes them happy. Women are so pressured by my essay The Windsor School, their significant other to do this act that they forgo their own feelings toward it and do it anyway, merely for argumentation of Manitoba/ College - NAVITAS their partner’s happiness.

Ricardo Landeros, 29, has never broken up with a woman because she would not give him a blow job, but has pressured a woman into giving him one. He says that women need a little more persuasion when it comes to blow jobs. Landeros believes that it’s all talk from write for money, women because eventually they’ll do it. “Sometimes women say that they don’t want to do it because they think it’s wrong,” said Landeros. “I think that women don’t give blow jobs because they don’t like the taste. Examples Of Academic Writing Of Applied Sciences! But you’ll be surprised at how many people don’t mind swallowing.” Daniel Cisneros, 20, has a different point of view on the issue. He has never pressured a woman into giving a blow job. My Essay The Windsor School! He says that it came up many times, but it was never a task for paper of Manitoba/ International - NAVITAS them. “To me some women like to give blow jobs because it is write my essay for money The Windsor School a satisfying pressure for them, and others simply don’t because they’re just not into that kind of article content, stuff,” said Cisneros. Fanny Cano, a junior at write for money, CSUN, has been with her boyfriend for over a year.

She has only been with one person sexually and feels that sex is an how to a descriptive essay Anne’s School, emotional connection. Because of that, she feels that giving her boyfriend a blow job is not a connection. Though Cano’s boyfriend has never pressured her into write School, giving him one, she has attempted to. “I’ve tried once for like five seconds and it was not my style,” said Cano. “It just seems wrong to quiz Polimoda, me.” Jessica Medina, a 20-year-old CSUN student, has been with her boyfriend for over two years and feels sex is a great thing and a very important part of the my essay for money relationship. Medina has never been pressured into a comparison contrast essay, doing anything that she has not wanted to do, including giving a blow job. Medina likes giving her boyfriend blow jobs because she wants to satisfy him. Being intimate with your partner shouldn’t be about feeling forced into pleasing the other. The person, in this case the girlfriend, should want to write my essay for money The Windsor, please. To see a special statement from the editorial board regarding comments posted about this story, see here. M.E.Ch.A focused on a descriptive a picture Queen School, xenophobia at write for money The Windsor School, annual Endependence Day.

Mattes, Satins, and Glosses: Fall Lip Trends. Weekly Picks: Beyond Fest, Los Angeles Music Video Festival, Haunted Hayride and writing Stonar more. I have no problem with the subject of this article, but the writing tastes bad in my mouth. It is every boys fantasy to fill their aggressiveness. and it is a wifely duty to make the husband satisfied in write The Windsor School, making love. I don’t mean to pile on to all the negative responses, but, seriously, what the hell? I’m not trying to sound like a prude or like this article is detestable, because I don’t think that’s necessarily the case. But how about the fact that this isn’t news.

Why is this in the paper? Who in critical quiz Polimoda, the newsroom thought this was a good idea? I guess I’m not entirely certain, all the time, what passes for journalism these days, but if these are the my essay for money School types of tactics we need to of academic essays University of Applied, resort to in order to write my essay, find readers for article writing Stonar our paper, then the Sundial is really in trouble. Whatever happened to some good ole fashion investigative reporting? How about a cleverly written article or helpful muse? Rather than make a Watergate/Deepthroat joke (I got many), I’m just going to point out that all we’re doing here is selling sex and for money School stirring controversy for the sake of stirring controversy.

I’m sure that this article has a place in a magazine of some kind, (it certainly is a topic of interest to many) but in the Sundial it just seems cheap and tacky. I should probably just stick to the Sports section, but way to lower the bar guys. Your boyfriend needs to cut bait and find a new girlfriend. Nothing personal, but I’ve been down this road before and if it takes 4 years for writing a comparison contrast essay St. John's-Ravenscourt School one of you two to do something sexual that’s important to my essay, the other one, it’s just not going to work. Sure, you two could just gloss over it and pretend it’s not a problem, but this is how to write about Queen eventually going to write for money School, lead to scholarship writing help The University, his having an my essay for money The Windsor, affair with someone who will do what he wants in bed. Argumentation University International College Of Manitoba - NAVITAS! It doesn’t mean he doesn’t love you. It doesn’t mean that you’re wrong.

It just means that you two aren’t compatible. There are guys out there who aren’t all that interested in getting a blowjob; they just want to make out and have intercourse. That’s the kind of guy you will be successful with long-term. Good luck! I just love giving to write School, my girlfriend a “blowjob” (: Greetings from Serbia – Europe.

Another ‘blow’ to paper of Manitoba/ International College, CSUN’s credibility with this gem. After reading this article, there no doubt in my mind that the Sundial is an absolute JOKE of a newspaper. Do they just let anyone pen articles for this paper? Does anyone even proof read them for write for money grammatical accuracy — or good quality writing and material for that matter? And that photograph, I have no idea why it was even included. A shot of examples of academic writing essays Sciences, a back of a girl’s head that contributes absolutely nothing to this already pitiful article? Why even include a photo of write my essay The Windsor School, some girl’s head in some dude’s crotch? I think anyone needed to be shown how a ‘blow job’ is performed. Useless.

And in response to the above comment, I am in no way a conservative or a Republican — not even close. I just cannot believe the lack of talent or tact in this ‘newspaper’ staff. After reading this article, there no doubt in my mind that the Sundial is an absolute JOKE of a newspaper. Do they just let anyone pen articles for critical thinking this paper? Does anyone even proof read these articles for grammatical accuracy — or good quality writing and material for that matter?

And that photograph — was that necessary? A shot of a back of my essay, a girl’s head that contributes absolutely nothing to this already pitiful article? Great photography skills ;) And in response to the above comment, I am in no one way a conservative or a Republican. Argumentation University Of Manitoba/ College - NAVITAS! I just cannot believe the lack of The Windsor School, talent or tact in this newspaper staff…

I don’t think she has done any thing wrong .Article was good and at least. she got some projection with this. Article Content Stonar! What she wrote is a real thing and for money The Windsor all of. us should accept it . Good thing she wrote something innovative about which nobody. The title of the article should of article School, been “Are blowjobs patriarchal?”

But who cares, this is a small fry newspaper which I doubt anybody of any significance reads. Capsule review: This is a rather shabby version of what is written in Cosmo week in The Windsor School, week out. I think most criticism written on this forum is how to a picture Queen overly harsh and seems to be rather vindictive. Does an article this low profile deserve a detailed critical analysis? Not really. So what’s the real story with the extended essays on its apparent vulgarity and lack of academic merit?

To be honest, this article makes me want to read the Sundial more. It is relevant, not only cos I am a 20something male but when I meet a girl in school or wherever that I like, I imagine how we’re gonna watch movies and laugh and share icecream and for money The Windsor School invariably how she is going to suck the oxygen pipe of argumentation University of Manitoba/ of Manitoba, mine. My Essay For Money The Windsor! It is very important to me- if done right, I would instinctually want to writing essay St. John's-Ravenscourt, please the girl back as much as she has done to me or even more (like buying her a Snickers Bar, Almond Flavour ) This article gives me an insight to the female mind, and then I can move on to the write The Windsor School classifieds and call the sperm donor ads, just before I read the opinion piece and an article about the examples Saxion University Sciences sailing club. Do you see the variety? And I think they should put spy webcams on sierra hall rooftop so we can, as a community see couples try to do non-verbal things. We need reasons to write for money, stay on campus longer. if you want to learn how to actually give a great blow job, then I recommend you all check out jacks Blowjob lessons. Orgasming for a BJ is one of the best feeling a guy can ever experience. Sometimes its even better than sex.

Regardless if its degrading or not, it is something that must be done to keep a man happy. All girls need to take that into how to a descriptive essay about a picture Anne’s School, consideration hooking up with a guy, especially if they expect a guy to go down on them. Vagina does not always taste or smell great either. But men sacrifice taste in order to write my essay The Windsor School, please their woman. So why shouldn’t a girl do the same to writing St. John's-Ravenscourt, a guy ? what is this? does she want a job as a journalist for playboy or hustler?

This is not a topic that should be discussed in a public paper anyone can just pick up and read. Had this woman done any research, she would understand how this has been a degrading act committed by many men in history to write my essay The Windsor School, demean and scholarship The University put down women. She didn’t even mention the diseases that could be transmitted in this way or the emotional and my essay psychological implications involved. Content School! Just a badly worded and really bad article. Write For Money The Windsor! Also what is examples writing essays Saxion University with the picture? Jewish writing on an arm with the guy forcing the womans head into the guys crotch to write my essay The Windsor, make it look like either a forced or dominating gesture? Just inappropriate by of academic writing essays, all means. Thank you Dean for being the only person on this forum to make sense!! I completely agree about ur opinion on the picture and the Jewish writing on the arm was extremely unnecessarily.

Seriously, did they need to bring religion into this too? How is a blow job vulgar. Write My Essay School! Its a sexual technique for male stimulation. Argumentation Paper Of Manitoba! Men enjoy blow jobs, every single man in the world, regardless of what your lying boyfriend may have told you to put a smile on your face. And who, at a public university would have their world shattered by reading an article about a blow job. Does anyone here not remember the 90s? When you couldn’t surf the internet without being flooded with porn? Everyone in college today knows what a blow job is, has probably gotten or given one, and has no legitimate reason to be offended. Why is America so prude? Its sex! Your mom probably blew your dad before they conceived you, because that’s what normal people do.

One partner attempts to satisfy the write for money School other to writing The University, the best of write for money School, their ability, and hopefully if you are in a relationship with someone who isn’t selfish and pretentious, they’ll do the same. I would gladly please my female partner orally any minute of any day, and yes, I would receive some satisfaction myself. There is no reason to date someone who refuses to explore all of your sexual curiosities and desires. Write A Descriptive About A Picture Queen Anne’s School! Why share a life with some one who doesn’t enjoy what you enjoy. Write The Windsor School! Its a very simple concept. Stop wearing your ass’s for content Stonar hats and live a little. PS, one of write, Jesus’s closest friends sucked dick for a living! What a perverted desperate college kid. Can’t wait to see where you end up going in life with such pitiful and article content writing Stonar tasteless opiniated conviction like that. :)

This piece is damaging to write for money, the credibility of the paper and to The University of Brighton, that of the writer. It’s a waste of space and makes you all look silly. Editors: bad call running this one. Amber Starling: (Um, is that your real name or your porn name?)this one will for sure bite you in the rear six years from now when you’re applying for The Job of Your Life and you don’t get it because when they Googled you and found this. I am in no way offended by write, this article, but the use of the paper International - NAVITAS word blowjob is a little lowbrow. Perhaps you should use the traditional word “fellatio”.

Anyways, I’m unsure of the write my essay The Windsor School point of this. Yes, men love “fellatio” just as girls love “cunnilingus”. If girls weren’t getting any they’d probably ask for it too. Daily Sundial readers in need of LASIK surgery should reach out to LASIK Orange County eye professions to write about a picture, learn about the benefits of my essay The Windsor School, undergoing LASIK surgery. Sundial readers that want to protect their southern California homes from earthquakes should reach out to argumentation University College of Manitoba, the earthquake retrofitting experts at Weinstein Construction, who have over 40 years experience of write School, adding earthquake stabilizers to homes.