|Lester Maddox and the Pickrick Restaurant|
Lester Garfield Maddox, a devout segregationist, owned and operated a restaurant called the “Pickrick Cafeteria,” that was located at 891 Hemphill Avenue near the Georgia Tech campus. As depicted in this WSB clip, after Maddox had renamed it the Lester Maddox Cafeteria in the Fall of 1964, the restaurant itself was known more for what it represented than for its good food and affordable prices. Maddox and his customers supported segregation and opposed the federal government's intervention in such policies.
The Pickrick was open only to white customers and refused those who were black or those who were considered integrationists. The restaurant featured a wide selection of free segregationist literature and the “Make a Wish for Segregation” wishing well. Although Maddox owned the restaurant to make a living, he utilized its ability to attract media attention to voice his opinions and to gain support in the community.
The restaurant faced several problems, the largest of which was the Civil Rights Act of 1964 that made racial segregation illegal. It was Maddox’s open defiance of the Civil Rights Act that thrust him into the national spotlight. In 1964, he refused to serve three black students and chased them out with a gun while his white customers used axe handles. He contended that both his business and property were being threatened.
The federal government took Lester Maddox to court in the case Willis v. Pickrick Restaurant (1964), and ordered him to desegregate within twenty days. Rather than own an integrated restaurant, Maddox sold the Pickrick to two of his previous white employees, Roy Duncan and Edward Piper.
Donald L. Hollowell, the civil rights lawyer depicted in this WSB clip, spoke out against Lester Maddox. His actions as a lawyer had included defending the Reverend Dr. King and hundreds of other foot soldiers for civil rights. He also participated in cases that desegregated buses and integrated public facilities. Hollowell’s opinion of Lester Maddox was highly regarded in the Atlanta community' Hollowell's actions encouraged others to speak out against or challenge Maddox’s opinions. A majority of other elite figures, including former Georgia state representative Billy McKinney (father of the politician Cynthia McKinney), considered Maddox as the quintessential symbol of southern racism.
During his ownership of the Pickrick, Maddox twice ran for mayor of Atlanta and lost. In October 1965, he announced that he would seek the Democratic nomination for governor. True to his reputation, he ran a grass-roots campaign on platform based on segregation and resisting federal encroachment on state and individual rights. This proved effective for a majority of Georgia voters--Maddox was sworn in as governor on January 10, 1967.
To the surprise of many, Maddox instituted many social reforms, such as improving the prison system and promoting African Americans into more prominent government positions. He was the first Georgia governor to appoint an African American as the head of a state department--the Board of Corrections. He was also instrumental in the state's hiring of its first African American state trooper, its first African American Georgia Bureau of Investigations (GBI) agent, and its first African American members of draft boards.
Despite these positive measures, these actions were often seen as insincere. In 1968, for example, Maddox ordered a heavy police presence at the funeral procession of Dr. King, and he would not allow state facilities to fly the state flag at half mast. Maddox also opposed many civil rights agendas that were being pursued by the Democratic Party on a national level.
In 1971, after serving four years as governor, Maddox became lieutenant governor under the governorship of Jimmy Carter. The two men were constantly at odds and often brought their differences to light in the public eye. Maddox’s years with Carter proved to be his last in elected office. He lived the rest of his life riddled with medical problems and died in 2003.
Maddox's battles with the federal government and attorney Hollowell demonstrate the importance of court decisions in mediating civil rights disputes and pushing forward an agenda of integration and equality. From desegregating public facilities and forms of transportation, to affirming the legality of interracial marriages, to extending the right to vote to all citizens, the courts were integral to the success of the Civil Rights Movement in Georgia. Their role in such matters underscores the crucial nature of executive appointments of federal judges.
Suggested Resources (click here)
1. Go to the New Georgia Encyclopedia essay on Lester Maddox. Click on the right-hand video clip entitled "Lester Maddox: MLK Jr. Funeral." What do his remarks tell us about what "states' rights" meant to segregationists like him?
2. Do you think that Maddox ever regretted his actions? Or, did he act differently in order to be viewed differently by society?
3. Why might African Americans knowingly work at a restaurant that was owned by a segregationist?
4. Did Maddox's views and the actions taken against him help bring awareness of the Civil Rights Movement or did they hinder the Movement in Georgia?
5. Research the position of Governor Jimmy Carter on race. Why would he have selected Lester Garfield Maddox as his lieutenant governor?
Take it to the Streets!
As we were editing this essay for our site, one of our Research Assistants, Aggie Ebrahimi, discovered that she grew up in East Cobb County just a few doors down from Lester Maddox's house. She remembers that he displayed a sign, an anniversary present, that thanked God for giving him his wife. Forty-five days later, he added to the sign a lament that she had died. This sentimental side of Maddox may contrast with the public persona that is often associated with him. Choose one person from this list of public figures below. Write a story that depicts this person in a different light from how he or she is typically viewed. Make certain that you do not name the individual in your story. Then, read your story to your classmates and ask them to identify the person you wrote about.
President George Walker Bush
"Dice-K" or Daisuke Matsuzaka of the Boston Red Sox
Muqtada al-Sadr, the Shi'a leader of the Mahdi Army in Iraq
Colin Powell, former U.S. Secratary of State
Hugo Rafael Chávez Frías, President of Venezuela
Cynthia Ann McKinney, GA-Dem., U.S. House of Representatives, 1993-2003, 2005-2007
Writers: Heather Grimes, Ivy Howard, Seth Headrick, Victor Lane, Rebekah Martin, Colby McCulley, and Jacqueline McMullenin Dr. Barbara McCaskill's AFAM/ENGL 3230 class (Survey of African American Literature) at The University of Georgia, Spring 2007.
Editors and Researchers: Lauren Chambers, Christina L. Davis, Aggie Ebrahimi, Courtney Thomas, and Professor Barbara McCaskill
Web Site Designer: William Weems
Freedom on Film is not responsible for the content of external web sites.


Our planet is in trouble. The warming and poisoning of the earth is an alarming issue. The Sisters of Notre Dame are working alongside other environmental groups to help preserve the earth now and for future generations.
We are committed to doing all we can, individually and collectively, to preserve the magnificent earth the good God has given us.
Stewardship of the earth and its resources is an important dimension of our faith as well as our obligation as citizens of the earth.
Modern day martyr and Sister of Notre Dame de Namur Dorothy Stang gave her life for the poor and mother earth. Join with us by reading more about our priorities and sharing what you are doing to promote the safety of immigrants and the earth.
Here are things you can do:
- Consider a gift to the Sisters of Notre Dame de Namur to help us preserve the earth now and for future generations.
- Move your thermostat down 2 degrees in the winter and move it up 2 degrees in the summer.
- Recycle paper, aluminum, plastic, and cardboard. Conserve water. Purchase recycled materials.
- Carpool to school, athletic events, and social events.
- Purchase products from the rainforest that promote sustainable agriculture rather than items that contribute to deforestation such as mahogany furniture or beef from cattle raised in Brazil.
- Pass on some action you’ve learned to one of your friends or family members. Explain what you are doing and why—they may want to do it too!
- Get your school, neighborhood or community to participate in Earth Day.
- Contact local and national leaders. Attend and participate in town meetings.
- Become a registered voter and vote. Have a say in who is leading and how.


Black Hole Picture :
With one step at a time, the mystery of the mysterious Black Hole is slowly getting uncovered by our scientists and answer some of the many unanswered questions of the universe with proof.
The Planet Wide Virtual Array called ‘The Event Horizon Telescope (EHT)’ which holds the title of capturing the world’s first Black Hole Picture that was released on 10th April 2019 has revealed another Black Hole picture with a new Black Hole-mystery-solving feature that is yet another world’s first.
Picture of a Black Hole with magnetic fields at the edge.
Image credit: (NASA’s Goddard Space Flight Center/Jeremy Schnittman)
This Black Hole is situated at the center of the galaxy named ‘Messier 87′ or M87 which is located some 55 million light-years away from our solar system.
This new Black Hole picture with its magnetic fields reveals the strong signature of magnetic fields, the property of polarisation along with polarised light that is extremely close to the edge of the black hole.
More for you:
> Artemis Moon Mission by NASA, The Most Ambitious Mission Ever…
> Supermassive Black Hole Explosion is the Biggest Ever Recorded…
> Here’s What Perseverance Rover Heard on the Red Planet…
This milestone wasn’t achieved over-night. Over 300 researchers from Asia, Africa, North America, South America, and Europe have dedicated years of research and data collected by EHT using the 1RAM NOEMA Observatory, ALMA, the 1RAM 30-meter Telescope, the James Clark Maxwell Telescope (JCM), APEX, LMT, SMT, SMA, the South Pole Telescope (SPT), the Greenland Telescope (GLT), and the Kitt Peak Telescope to capture and create this Black Hole Picture.
“We are now seeing the next crucial piece of evidence to understand how magnetic fields behave around black holes, and how activity in the very compact region of space can drive powerful jets that extend far beyond the galaxy,” said Dr. Monika Moscibrodzka, the coordinator of the EHT Polarimetry, in a report.
Although this picture shells some light on the emission of the bright jets of energy and matter from the center of the M87 galaxy, the scientists still aren’t sure about how these supercharged energy jets bigger than the clusters are shot from the core.
The team stated the stunning resolution of the Black Hole picture obtained using the EHT is equal to the resolution required to spot and measure the size of a visiting card on the Moon’s surface.
The research was published in The Astrophysical Journal.
The EHT is on course to unravel much more mysteries of the Black Hole in the coming days, the team added.
“The EHT is making rapid advancements, with technological upgrades being done to the network and new observatories being added,” said Jongho Park a member of East Asian Core Observatories Association.
Likitha · April 5, 2021 at 11:01
We really gaining more knowledge.
keep updating us with more information.


What are ASEAN’s commitments, at the national and regional levels, to reduce global greenhouse gas emissions? Can you elaborate on policies, programmes, initiatives, and innovations within the region to meet these commitments?
ASEAN commitments towards climate change responses date back to the early 1990s, when the United Nations Framework Convention on Climate Change (UNFCCC) was formulated and ratified. ASEAN is fully committed to the objectives of the Paris Agreement and has played active and leadership roles in addressing climate change issues in the global community. The ASEAN Leaders have reaffirmed continuously our commitments to the UNFCCC and Paris Agreement—in alignment with the broader outcomes of the 2030 Agenda for Sustainable Development. ASEAN Declarations, Statements, and events have been regularly released and organised, for instance, the Special ASEAN Ministerial Meeting on Climate Action and an expanded session with partners in 2018 to respond to the Talanoa Dialogue. With the ASEAN 2025: Forging Ahead Together, the ASEAN Socio-Cultural Community Blueprint 2025, the governance system, strategy, and action plan on environment and climate change have been established and implemented.
would like to highlight that all the ASEAN Member States are parties to UNFCCC and Paris Agreement. Member States have proactively taken measures to address the issue at local, national, regional levels by setting various mechanisms, policies, strategies, and action plan for greenhouse gas reduction and climate adaptation. Regularly, Member States report their progress and achievements in climate action in their respective countries, and especially during each Conference of Parties session of UNFCCC. Currently countries are working on the updates to their Nationally Determined Contributions (NDC), which set concrete targets for each country to reduce emissions and adapt to the impacts of climate change by 2030. Although the commitment to greenhouse gas reduction targets is voluntary for least developed countries like Cambodia, setting clear targets demonstrates ASEAN Member States’ serious commitment to addressing this disastrous global threat. Alongside, ASEAN is working closely with many partners and international organisations at various levels to advance climate action in the region through joint initiatives or policy dialogues, such as the annual ASEAN-EU High Level Dialogue on Environment and Climate Change.
One of the key commitments made by ASEAN is to achieve a 21.9 per cent reduction in energy intensity compared to 2005 levels. This exceeds the 2020 target set by the ASEAN Plan of Action for Energy Cooperation 2016–2025. There are also other initiatives being developed to target specific sectors, such as the ASEAN Fuel Economy Roadmap for the Transport Sector 2018–2025.
To expedite climate action and the achievement of NDC ambitions, the ASEAN Member States, partners, and international organisations may need to continue and further enhance international cooperation and assistance, post-pandemic, in the area of financing, the transfer of technology, and capacity-building, for both climate change mitigation and adaptation.
The effects of global warming, e.g. destructive typhoons, drought, are felt by many communities in Southeast Asia. How is ASEAN addressing these challenges?
Resilience and adaptation to climate change are ranked as the top priority for ASEAN as stipulated in the ASEAN 2025: Forging Ahead Together. The ASEAN region is one of the world’s most climate disaster-prone regions, in which several of the ASEAN Member States, including Cambodia, are listed as among the most vulnerable countries in the world. For this reason, Cambodia has national adaptation plans prepared along with existing interventions in place.
ASEAN is working to complement national responses through regional initiatives, namely ASEAN Agreement on Disaster Management and Emergency Response, which includes mechanisms to improve our joint responses to emergencies related to extreme climate events. Adhering to the Sendai Framework for Disaster Risk Reduction 2015-2030, Member States have fully committed to prevent new and reduce existing disaster risk, reduce hazard exposure and vulnerability to disasters, and increase preparedness for response and recovery, thus strengthening resilience. Additionally, there is an ongoing effort to establish a Southeast Asia Disaster Risk Insurance Facility, aiming to improve disaster risk assessment, and financing and insurance solutions. At the same time, ASEAN continues to mainstream disaster risk reduction (DRR) into climate change adaptation (CCA) policy by (i) facilitating the establishment of a clear institutional and policy framework on DRR and CCA integration at the regional and national level, and (ii) supporting capacity building initiatives for the Member States on hazard and risk mapping through integration of future climate change projections to minimise the potential impacts posed by drought, floods, and landslide disasters.
Again, to ramp up our efforts to tackle climate risks, further stepping up collocation, partnership development, and cross-sectoral coordination are essential for building stronger resilience against disasters.
To what extent has ASEAN engaged the private sector and civil society in efforts to reduce the region’s carbon emission and to respond to the impact of climate change on our communities?
As reflected in the ASCC Blueprint, ASEAN is committed to lifting the quality of life of its peoples through cooperative activities that are people-oriented, people-centred, and geared towards the promotion of sustainable development. In line with the motto, “ASEAN is a Community of Opportunities for All,” ASEAN is open to work as a community. ASEAN works collaboratively with many partners, international organisations, civil societies, and the private sector at different levels and sectors dealing with climate change issues. For example, civil society constituencies recently had an interface with the ASEAN Working Group on Climate Change and submitted their Statement to be taken into account in the formulation of the ASEAN Joint Statement on Climate Change at the UNFCCC COP26. Annual ASEAN Climate Change Partnership Conferences, among others, also provides a platform for dialogue and engagement with various stakeholders and actors, including relevant sectoral bodies, partners, civil society and private sector, to join hands in addressing climate change.
Moreover, ASEAN Member States have established numerous mechanisms and initiatives at their respective countries to engage the private sector and civil society in climate change responses. In Cambodia, the civil society and the private sector are integrated in our policy dialogue mechanisms. They act as partners to the Royal Government of Cambodia for the implementation of adaptation or mitigation programmes. They have an essential role to play, based on their comparative advantages. Civil society organisations support effective engagement of affected communities, while private investment is crucial for financing climate change response.
How has Cambodia been impacted by climate change? Can you share with us Cambodia’s policies, programmes, or strategies for addressing climate change challenges?
Climate change is now a major threat to Cambodia’s economy and society. Water resources are under stress, which impact both agriculture and health in rural areas, with women and children among the most vulnerable groups. Higher temperatures can impact worker productivity and health in key sectors of our economy, including not only agriculture, but also manufacturing and construction. Extreme weather events have become more frequent and the costs of maintaining and upgrading our infrastructures have gone up.
Addressing climate change is identified as one of the key priorities for Cambodia. Our national budget allocation for climate-related initiatives has almost quadrupled in the last 10 years. The following are some of the policies and programmes that Cambodia has adopted and implemented to respond to climate change impacts:
- Cambodia Climate Change Strategic Plan 2014-2023 was developed to guide Cambodia towards a green, low-carbon, climate-resilient, equitable, sustainable, and knowledge-based society. It also aims to reduce vulnerability of the most vulnerable groups and critical (natural and social) systems to climate change impacts, and to shift towards a green development path by promoting low-carbon development and technologies, and to promote awareness and participation of the public in climate change response action.
- In addition, the Rectangular Strategy was developed to minimise environmental impacts, enhance the capacity to adapt to climate change, and contribute to reducing the global climate change to ensure sustainable development. It also promotes the implementation of measures to prevent and reduce communicable diseases by cooperating with the community and stakeholders to raise awareness on hygiene, food safety, healthcare, effects of chemical products, alcohol and tobacco, and impacts of climate change on human health.
- At the same time, the National Strategic Development Plan (NSDP) was designed to meet Cambodia’s commitments to climate change action, including decarbonisation of the economy. It includes the management of the environment and natural resources, which are key for sustainability and stability of Cambodia’s economic growth and development. The NSDP also includes a Strategic Plan for Gender and Climate Change, Disaster Management and Green Development and a Master Plan on Gender and Climate Change (2013-2022).
- Nationally Determined Contributions set out the national approach to reduce emissions and adapt to a changing climate, as part of the Paris Agreement signed in COP 21 in Paris in 2015. The increased ambition through the NDC process covers mitigation commitment, adaptation action, finance, transparency framework, and governance. Cambodia expects to submit its NDC update by October 2020. In August 2020, Cambodia submitted its First Biennial Update Report.
- National Green Growth Roadmap (2009) and National Policy on Green Growth and National Strategic Plan on Green Growth (2013-2030), which were launched in 2009 and 2013, respectively. The green growth policies aim to boost Cambodian economy towards a green economy, focusing on efficient use of natural resources, environmental sustainability, green jobs, green technology, and economic reform, placing more consideration into green incentives, such as green tax, green finance, more importantly green credit, green microfinance, and green investment.
- In 2015, the Royal Government of Cambodia established the National Council for Sustainable Development, an inter-ministerial body, that aims to promote sustainable development in Cambodia. Climate change mitigation and adaptation, green growth/green economic development, and biodiversity conservation are some of key priorities of this Council.
- Our top priority is adaptation. Cambodia has adopted the National Adaptation Plan Financing Framework and Implementation Plan, and continues to mainstream climate resilience into development planning. A study on Public Perceptions of Climate Change in Cambodia (Knowledge, Attitude, and Practice) has also been conducted. Additionally, in order to minimise the impacts of climate change on our economy and society, Cambodia needs to build climate-proof infrastructures and to promote climate-resilient agriculture, along with delivering social services such as health and education, in the context of rising temperatures and extreme events, and to protect the health and productivity of our workers.
For a developing country like Cambodia, international support is crucial to achieve these objectives.
For climate mitigation, the Royal Government of Cambodia has been working with partners to implement a range of international interventions, including Clean Development Mechanism, Joint Credit Mechanism, Nationally Appropriate Mitigation Action, and Gold Standard and Verified Carbon Standard. We also see opportunities in promoting green growth/green economic development to fight against climate change by reducing greenhouse emissions. The share of solar power in our installed electricity production capacity has increased from zero to almost 10 per cent in the last four years. We have also launched initiatives to promote green buildings and made some significant progress in raising financial and technical support for forest conservation through the Reducing Emissions from Deforestation and Forest Degradation (REDD+) initiative.
This is an ongoing battle, which requires long-term global commitments. We look forward to continuous cooperation within the ASEAN and beyond to achieve the goals of the Paris Agreement on climate change.


Horatio Hornblower Ship
In May of 1803, with war with France under Napoleon Bonaparte imminent, Horatio Hornblower was promoted from Lieutenant to Commander and appointed to command the Hotspur. He chose Lieutenant William Bush to serve under him as First Lieutenant. The ship gave formal salute to the French frigate Loire before war is declared.
Hotspur reconnoitred the approaches to the French naval base of Brest as part of the Inshore Squadron, and narrowly avoided capture when war was declared. While in command of the Hotspur, Admiral William Cornwallis instructed Hornblower to capture a convoy of ships carrying Spanish gold. Instead, Hornblower engaged an enemy frigate sent to warn the convoy and keeps it from accomplishing its mission. Eventually, through superior seamanship and skill, he drove it away.
In the Hornblower TV series, Hotspur was originally a British ship. She was eventually captured by the French. Hornblower found the Hotspur on patrol, and felt something was not right. After Hornblower and the crew discovers that the ship has been captured, they succeed in retaking it by boarding.


Ultrasonic Nebulizers-Yesterday, Today, and Tomorrow
Up to 10 percent of US residents use some form of aerosol medication, with most using a pressurized metered-dose inhaler (MDI).1 With the phasing out of chlorofluorocarbon-based MDIs, there has been a tremendous industry effort to provide alternative forms of aerosol therapy that are as effective, convenient, and inexpensive as the MDI. Although the pharmaceutical industry is investing a large amount of resources into the dry powder inhaler (DPI), a surprisingly robust entry in the competition to meet patients’ aerosol needs appears to be the ultrasonic nebulizer.
Most RCPs who have practiced for more than 15 years probably think of ultrasonic nebulizers as large, industrial-strength units composed of multiple components. These were wheeled on stands to the patient’s bedside or included as part of the humidification system in a ventilator circuit. These devices developed a reputation for being expensive and somewhat inconsistent in operation, requiring considerable practitioner intervention to ensure proper operation. Many facilities have limited these ultrasonic nebulizers to use for sputum induction.
The past year, however, has seen the introduction of several new ultrasonic nebulizers oriented toward use both at home and in the intensive care unit. As new uses for this technology develop, it is important for RCPs to understand its operating principles and the technical considerations necessary for device selection.
PRINCIPLES OF OPERATION
The ultrasonic nebulizer uses a piezo-electric crystal that vibrates at a high
frequency (greater than 1 MHz) to create an aerosol. The crystal transducer, composed of substances such as quartz-barium titanate, converts electricity into sound. The beam of sound is focused in the liquid above the transducer, creating waves. When the frequency is high enough, and the amplitude of the signal is strong enough, the waves crest, creating a geyser of droplets at the surface of the liquid.
Most large-volume ultrasonic nebulizers use a water bath as a couplant between the transducer and a cup (usually, a disposable plastic one) containing medication. The medication cup, which has a flexible diaphragm on the bottom, is seated in the couplant chamber and filled with enough water to allow a firm water seal between transducer and cup bottom. This water conducts sound energy from the transducer to the diaphragm; in turn, this vibrates the medication to produce an aerosol. These units tend to have rather high maintenance needs, with the couplant requiring frequent changes and the unit needing regular cleanings to minimize the buildup of any substances on the transducer.
Ultrasonic nebulizers tend to have higher outputs of solution (0.5 to 7 mL/min) and higher mist densities than conventional jet nebulizers. The particle or droplet size, expressed as the mass median aerodynamic diameter (MMAD), delivered by an ultrasonic nebulizer is related to the frequency at which the crystal vibrates. The frequency is usually set by the manufacturer for each individual model of nebulizer and is rarely adjustable by the user. The particle size is inversely proportional to the frequency. For example, one ultrasonic nebulizer that operates at a frequency of 2.25 MHz produces an MMAD of 2.5 mm, while a similar unit operated at 1.25 MHz produces a much less respirable, larger MMAD of 6 mm. The greater the amplitude, the greater the output from the nebulizer, up to the limit imposed by a device’s design (Table 1, page 100). Increases in amplitude beyond the specific upper limit of performance will not improve a device’s output. It should be noted that not all ultrasonic nebulizers produce aerosols that are primarily respirable (smaller than 5 mm).
Particle size and aerosol density are also affected by the source and flow of the gas that conducts the aerosols from the nebulizer to the patient. If the nebulizer is producing a steady output of particles, the greater the flow of gas through the chamber, the more diluted the same number of particles will be in the larger volume of gas. The faster the flow of gas, the greater the chance that large particles will be driven out of the nebulizer before they can coalesce with other particles and settle out of the stream. Low flow rates are associated with smaller particles and a higher density of mist. High flow rates yield larger particles and less density, but a greater direct output from the nebulizer. The larger commercial ultrasonic nebulizers use low-flow blowers to deliver air or other compressed gases through a flowmeter. A blender can be added to the delivery system to control the delivered gas concentration more precisely. Aerosol tubing, a mask, or a mouthpiece can be used to administer the ultrasonically nebulized solution.
Jet nebulizers cool during use, but the temperature of the solution placed in an ultrasonic nebulizer increases during use as a by-product of the energy required to vibrate the piezoelectric crystal. As the temperature increases, the drug may change in consistency or chemical composition, sometimes altering its effect on the patient.
Smaller ultrasonic nebulizers have been designed for individual-patient use. Often, they do not use water-filled couplants between the transducer and the medication, which is placed in the manifold in direct contact with the transducer. The transducer is connected to a power source (often, to increase portability, a battery). Small nebulizers, which incorporate the transducer manifold at the patient’s airway, usually rely on the patient’s inspiratory flow rate to draw the aerosol from the nebulizer to the lung. Consequently, patients should be encouraged to breathe with low to medium inspiratory flow rates for optimal delivery of medication to the lower respiratory tract.
The primary use for the ultrasonic nebulizer in most acute care facilities is sputum induction. Small-volume ultrasonic nebulizers have also been promoted for bronchodilator therapy in nursing homes or other extended care facilities, as an alternative to pneumatically driven small-volume nebulizers (SVNs). The small-volume ultrasonic nebulizer may offer an advantage because it has less dead space than an SVN; this reduces the need for a large quantity of diluent to ensure the delivery of drugs, although this has not been well documented. The self-contained portable power source of some units also adds a great deal of convenience for mobility. Ultrasonic nebulizers have been used to administer undiluted bronchodilators to patients with severe bronchospasm.2 Because the nebulizers have minimal dead space, the treatment time is shortened. Use of undiluted bronchodilators is not new and is typically included in the manufacturer’s product dosing information in the Physicians’ Desk Reference.
The advantages of the ultrasonic devices can be outweighed by their primary limitation: their high cost, which (at $150 to more than $1,000) may be up to 10 times that of a pneumatic nebulizer or 100 times that of an MDI or DPI. Because the ultrasonic nebulizer manifold is expensive, compared with a disposable jet nebulizer, some practitioners have suggested using a technique that employs a one-way valve between the medication chamber and mouthpiece (so that multiple patients can be treated consecutively without concern of infection). It has yet to be confirmed, however, that a simple one-way valve manifold is adequate protection against contamination of the medication chamber. In addition, contact with infectious secretions on the outside of the nebulizer manifold could result in transmission of pathogens from one patient to another.
The use of ultrasonic nebulizers is associated with a number of potential complications. These include overhydration, bronchospasm, infection, and disruption of the structure of the administered medication.3,4 Overhydration can occur because of a large fluid output from the nebulizer and its potential to deliver small particles directly to the lung parenchyma. Overhydration is of greatest concern after the prolonged treatment of neonates, small children, and other patients with fluid and electrolyte imbalances. Pulmonary secretions can also swell after treatment using an ultrasonic nebulizer.5
Bronchospasm can occur after ultrasonic nebulizer treatment. The delivery of cold, high-density aerosols has been associated with increased airway resistance and irritability in a number of patients.5 In addition, the sterile water administered through an ultrasonic nebulizer is known to be more irritating than normal saline.6
Medications administered by ultrasonic nebulizer can become more concentrated during treatment. This occurs because of the heat generated by the piezoelectric transducer and can result in a situation in which the solvent evaporates at a rate faster than that at which the drug evaporates, leaving the active drug in solution, at a stronger concentration. Nebulizers with acoustic outputs of more than 50 W/cm2 cause changes in the structure of aerosolized medications.6 If the power output of the nebulizer is 50 W/cm2 or less and the aerosol output is less than 2 mL/min, it is reportedly safe to use to deliver medications.7
One novel small-volume ultrasonic nebulizer uses a metering device to inject a small amount of undiluted medication into the nebulizer, which nebulizes the dose over a 60-second period. This handheld, battery-operated device appears to meet the criteria of efficacy and convenience, with the ability to nebulize virtually any solution that it may be safe to inhale. The small, precise dose reduces waste (an important factor for users of expensive medications). The short time needed for nebulization not only reduces treatment time, but decreases the time during which the transducer could create medication-altering heat.
Small-volume ultrasonic nebulizers recently have been developed for use in the administration of aerosols during mechanical ventilation. Pneumatic and jet SVNs have been shown to be inefficient in delivering medication to the patient during mechanical ventilation8 and have the disadvantage of adding a considerable additional flow of gas into the circuit, which can affect both lung volumes and airway pressures. Early reports9 indicate that ultrasonic nebulizers deliver more drug to the lower respiratory tract (in vitro) than SVNs, with virtually no alteration in ventilator parameters or alarms during administration. The greatest problem noted for these nebulizers is their weight, which impairs their ability to be placed in the ventilator circuit without placing too much weight on the patient’s airway. N
James B. Fink, MS, RCP, RRT, is a program analyst, respiratory care, Edward Hines Jr Veterans Administration Hospital, Hines, Ill.
1. The National Lung Health Education Program. Strategies in preserving lung health and preventing COPD and associated diseases. Chest. 1997;113:123S-163S.
2. Ballard RD, Bogin RM, Pak J. Assessment of bronchodilator response to a b-adrenergic delivered from an ultrasonic nebulizer. Chest. 1991:100:410-415.
3. Chatburn RL, Lough MD, Klinger JD. An in-hospital evaluation of the sonic mist ultrasonic room humidifier. Respiratory Care. 1984;29:893-899.
4. Doershuk CF, Mathews LW, Gillespie CT, Lough MD, Spector S. Evaluation of jet type and ultrasonic nebulizers in mist tent therapy for cystic fibrosis. Pediatrics. 1968;41:723-732.
5. Phillips GD, Millard FJL. The therapeutic use of ultrasonic nebulizers in acute asthma. Respir Med. 1994;88:387-389.
6. Boucher RGM, Kreuter J. Fundamentals of the ultrasonic atomization of medicated solutions. Ann Allergy. 1968;26:59-63.
7. Lewis RA, Ellis CJ, Fleming JS, Balachandran W. Ultrasonic and jet nebulizers: differences in the physical properties and fractional deposition on the airway responses to nebulized water and saline aerosols [abstract]. Thorax. 1984;39:712.
8. Fink JB. Placement of an ultrasonic nebulizer at the ventilator circuit does not reduce aerosol delivery during CMV. Respiratory Care. 1998. In press.
9. McPeck M, LeBlanc DS, Smaldone GC. Ultrasonic nebulization with a contemporary flow-triggered ventilator. Respiratory Care. 199;42:1059.


It is a great pleasure for me to place the Sixteenth (Revised) Edition of Applied English Grammar and Composition in the hands of the readers. The material has been rewritten/reset according to the latest guidelines issued by CBSE regarding Continuous and Comprehensive Evaluation (CCE) in English Communicative & Language and Literature.
Examples and exercises have been framed keeping in view the latest sample papers and syllabus for English—Communicative & Language and Literature issued by CBSE. Since, the emphasis has shifted to thinking skills such as inference, evaluation and analysis, arriving at conclusion or presenting argument with supporting examples, care has been taken to develop, improve and sharpen such skills in students.
As per the new syllabus for Class IX, Section A: Reading, for SA–I, consists of two reading passages–Factual and Discursive. In SA–II, again two reading passages–Factual and Literary (Prose only) and Open Text Based Assessment (OTBA) to test analytical and critical thinking skills. In Section B: Writing and Grammar, Diary entry is a new topic whereas Letter Writing, Debate, Speech, Notice and Short Newspaper Report have been deleted.
Similarly for Class X, Section A: Reading consists of two unseen passages–Factual and Discursive. Section B: Writing and Grammar is restricted to Letter to the Editor/Article and Short Story.
This book Useful for Class IX & X students.
1. Reading Skills
2. Writing Skills with Grammar
3. Literature Textbook and Long Reading Text
4. Assessment of Speaking and Listening (ASL)