Sunday, May 24, 2020
1. The title of the book is called Home written by Toni Morrison. 2. Home is about a Korean War veteran named Frank Money who needs to save his sister from dying. The story starts with Frank describing a scene from his childhood with his sister. They were in a field with horses he describes the horses being beautiful and brutal, but on the other side some men were burying a dead African American in a hole. When Frank becomes an adult he is soon committed to a mental hospital after his time in the war. Frank soon gets a letter stating that his sister was in danger and could die if he did not hurry to save her. Then he remembers his family being evicted and not being able to take any possessions. Frank then escapes the bastion of theÃ¢â¬ ¦show more contentÃ¢â¬ ¦One of the first minor characters that reader encounters is Reverend John Locke. He helps ply a major role by offering Frank supplies and shelter for a while before he left to continue his search. Some other important minor characters include the group of Good Samaritans that also he lp Frank on his travels by offering money and supplies. These minor characters help prelude to the theme of good versus evil because while Frank was in the army he was not too proud of what he did and seeing these people help him reminds him of what he did. 7. The setting help establish a theme by being part of the theme itself or being reference to it. In Home the plains with the crops were a beautiful place with majestic creatures running around but is turned brutal when the horses in the field start to fight each other. Also the place was nice and calm then Frank and his sister see some men drop a dead man in a hole and didnÃ¢â¬â¢t even care about him and covered in in dirt. Different settings can help display many different themes, some more than just one theme. 8. The primary theme in Home is that of good versus evil within man. Also how man react to different situations that involve good and evil choices. There are many different examples within the text that talk about the good and evil choices of man. The time period that this novel takes place is very racist because African Americans havenÃ¢â¬â¢t learn the civil rights that they have today. Many examples of racist and evil actsShow MoreRelatedHome by: Toni Morrison Essay1150 Words Ã |Ã 5 Pageseach other becomes more evident. Frank and Cee Money, the protagonists of Toni MorrisonÃ¢â¬â¢s Home, exemplify this powerful need, a need that at times flirts with greed. The reason Frank feels so responsible for Cee is due to the fact while growing up they had neglectful parents as well as an abusive grandmother, his failed relationship with Lily, and lastly him facing his inner turmoil due to his actions in Korea. Toni Morrison states numerous times in the text, how Frank would do anyth ing for Cee. FrankRead MoreMorrisons View on Gender in the Black Community Between 1919 and 19651362 Words Ã |Ã 6 PagesIn the novel Ã¢â¬Å"SulaÃ¢â¬ , Toni Morrison presents a very different view on gender in the black community between 1919 and 1965. Written in 1973 after the Civil Rights movement and during the feminist movement, Morison breaks down the traditional gender barriers from as early as 1919, proving that black females were Ã¢â¬Å"womenÃ¢â¬ much sooner than their white Ã¢â¬Å"ladyÃ¢â¬ counterparts. Morrison depicts matriarchal homes where the women are the dominant figures who even go as far as to emasculate their male oppositesRead MoreUse of Violence in Beloved by Toni Morrison Essay668 Words Ã |Ã 3 PagesAs much as society does not want to admit, violence serves as a form of entertainment. In media today, violence typically has no meaning. Literature, movies, and music, saturated with violence, enter the homes of millions everyday. On the other hand, in Beloved, a novel by Toni Morrison, violence contributes greatly to the overall work. The story takes place during the age of the enslavement of African-Americans for rural labor in plantations. Sethe, the proud and noble protagonist, has sufferedRead MoreThe Bluest Eye By Toni Morrison1561 Words Ã |Ã 7 PagesBeloved is one of the most beautifully written books and Toni Morrison is one of the best authors in the world. After reading the Bluest Eye and seeing how captivating it is, it is not highly expectant to think that Beloved to be just as enchanting. Anyone who has read Beloved would read it again and those of us who have not should be dying to read it. Beloved is a historical fiction novel based on a true historical incident. Beloved is setRead MoreBeloved, By Toni Morrison Essay1576 Words Ã |Ã 7 Pagesreading Toni MorrisonÃ¢â¬â¢s novel Beloved, I could not help but feel shocked and taken aback by the detailed p icture of life she painted for slaves at the time in American history. The grotesque and twisted nature of life during the era of slavery in America is an opposite world from the politically correct world of 2016. Morrison did not hold back about the harsh realities of slavery. Based on a true story, Toni Morrison wrote Beloved about the life of Sethe, a slave and her family. Toni Morrison leftRead More Sexuality and the Grotesque in Toni Morrisons Beloved Essay887 Words Ã |Ã 4 Pages Sexuality and the Grotesque in Toni Morrisons Beloved Grotesque images of rape, murder, and sexual abuse are recurring throughout Toni Morrisons novel Beloved. The ideals of the white oppressor, be it murder, rape, or sexual abuse were powerful forces that shaped the lives of many of the characters, especially the character Sethe. Rape and sexual abuse are two grotesque instances expressed throughout the novel. The most often referred to is the incident when SchoolteacherRead MoreBiography of Toni Morrison1620 Words Ã |Ã 7 PagesToni Morrison Born on February 18, 1931, in Lorain, Ohio, Toni Morrison is a Nobel Prize- and Pulitzer Prize-winning American novelist, editor and professor. Her novels are known for their epic themes, vivid dialogue and richly detailed black characters. Among her best known novels are The Bluest Eye, Song of Solomon and Beloved. Morrison has won nearly every book prize possible. She has also been awarded honorary degrees. Early Career Born Chloe Anthony Wofford on February 18, 1931, in LorainRead MoreThe Dead Of 9 / 11, And Toni Morrisons The Colossus Of New York900 Words Ã |Ã 4 Pagesof Ã¢â¬Å"The Colossus of New YorkÃ¢â¬ by Colson Whitehead and Ã¢â¬Å"The Dead Of September 11Ã¢â¬ by Toni Morrison they both speak on the event of 9/11 , but MorrisonÃ¢â¬â¢s poem is more heartfelt and sad because she uses a more direct approach to get the audiences attention. To compare both readings obviously they on the topic of 9/ll ,but they also explain the emotion and uses imagery of that horrible day . Toni Morrison states Ã¢â¬Å"Speaking to the broken and the dead is too difficult for a mouth full of bloodRead MoreThe Song Of Solomon By Toni Morrison1716 Words Ã |Ã 7 PagesMilkmanÃ¢â¬â¢s Attempt to Find what was Stripped from his Enslaved Ancestors in Song of Solomon Identity, what makes a person unique, was one of the many things that were stolen from the Africans as they were enslaved in America. Song of Solomon by Toni Morrison exemplifies the struggle that this situation created for the black community, lasting for centuries to follow. Milkman is the son of the Dead family and the main character of the book. He demonstrates the struggle to find his identity and his rootsRead MoreBeloved by Toni Morrison1455 Words Ã |Ã 6 PagesThroughout history, numerous people were victims of slavery. Many people were tortured and worked to death and suffered horrifically. Not many slaves knew their mothers because they were torn from their homes. Many slave women were robbed of their innocence by their masters. Behind the face of every slave, there is always a very traumatic unforgettable story which is not something to pass on, but a lesson to remember from repeating same mistake again. Only a handful of slaves learned to read and
Wednesday, May 13, 2020
Introduction A case study is defined as Ã¢â¬Å"a report of case materials obtained while working with an individual, a group, a community, or an organization. Case Studies illustrate a problem; indicate a means for solving a problem; and/or shed light on needed research, clinical applications, or theoretical materialsÃ¢â¬ (APA, 2010, p. 11). The goal of this paper is for me to conduct a case study on myself and explain what I have learned about research at an introductory level, and how I evaluate or critique it from a biblical, Christian perspective. The Subject: Jasmine The subject of this case study is a 19-year-old student, named Jasmine. Prior to taking this class, Jasmine never used the APA style in any of her previous classes. She did not know what to expect from taking this class, but she was very excited to learn. At the beginning of the course, Jasmine was overwhelmed with the amount of work she saw on the syllabus. She did not know how to conduct research, let alone conduct a case study. She began each week reading the assigned materials and slowly became familiar with the information and began learning a lot about research. As time went on, and God gave her strength, Jasmine became confident in what she was learning and learned a lot of information that she will continue to use in future classes. Learning About Research Through this course, the student has learned a lot about the research method as well as the APA style. Research is defined as Ã¢â¬Å"studiousShow MoreRelatedWhat I Have Learned About Research At An Introductory Level1776 Words Ã |Ã 8 PagesThroughout this course I have learned many things about research at an introductory level. Research is a critical part of all of our lives in many ways. God blesses each of us with a degree of common sense and we all learn from observing others even as babies, we learned behaviors and skills by observing our parents. Walking through experiences throughout life teach us a lot we need to know as well but sometimes we have to take a better approach when we need to learn about certain things. ManyRead MoreWhat I Learned About Research At An Introductory Level? Essay736 Words Ã |Ã 3 PagesMethods in Behavioral Research, the author clearly defines the case study as Ã¢â¬Å"an observational method that provides a descripti on of an individualÃ¢â¬ (Bates, 2012, pg. 121). The objectives of this course fitting to our syllabus were to familiarize us to the practices of psychological research, to advance our understanding of how research is completed and the methods used to do it, and to give us the capability to communicate knowledgeably about the ideas following the research procedure. This paperRead MoreStatement of Teaching Philosophy, and My Experience Teaching Chemistry in India1063 Words Ã |Ã 5 Pagesonly load their minds, he cannot quicken them.Ã¢â¬ Ã¢â¬ ¦ Rabindranath Tagore (Nobel prize in literature in 1913) This is my favorite quotation because it express what, I think, is the essence of teaching and learning. As a student, I have observed that the best teachers were those who cared the most about teaching. It is noteworthy to mention that, I loved the way of my organic chemistry teacher taught conformational chemistry by using models. Therefore, a teacher has to create a way to teach the fundamentalRead MoreWhat I Have Learned And Perfected While Taking This Course934 Words Ã |Ã 4 PagesResearch can be a very scary topic when it is first introduced to a class, and I was that scary student. Research to me was like learning how to swim for the first time with a life vest on, and my heart beating 100 miles per hour because IÃ¢â¬â¢m so afraid. Taking off my life vest and diving into this research course has been very rewarding for me. I have learned so much in such a short amount of time. It has open my eyes up to a variety of ways I can start and conduct my research. Research is not soRead MoreMy Day As An Emergency Room Volunteer852 Words Ã |Ã 4 Pagesbegins to regain consciousness. Later, after the excitement had passed, I learned what brought him here. He is diabetic and couldnÃ¢â¬â¢t afford to properly manage his condition. He had fainted due to hypoglycemia and hit his head. He had almost lost his life because of the unfortunate financial realities of modern healthcare. In that moment, I came to appreciate the very real cost of disease and the incredible role physicians have in ameliorating it. This formative experience was the beginning of my pathRead MoreWhat I Learned About Research At An Introductory Level As A Case Study1069 Words Ã |Ã 5 PagesIntroduction Within the eight weeks of this course, we learned a lot about psychological research. This course provided an understanding of how research is completed. This course also gave an understanding of what methods to utilize based on that particular research that is being conducted. In this paper I will discuss exactly what I learned about research at an introductory level as a case study. In the field of mental health, professionals must be constantly looking for ways to help their patientsRead MoreMy Future Career As A Law Enforcement Officer1821 Words Ã |Ã 8 PagesOver the last seven weeks students have dove into the study of research, receiving an introduction to a deeper level of conducting and reinterpreting different research methods. Questions such as, Ã¢â¬Å"What have you learned about research at an introductory level?Ã¢â¬ and Ã¢â¬Å"How do you evaluate or critique this from a biblical, Christian perspective?Ã¢â¬ will be answered in the personal case study that will be conducted on myself. The fascinating thing about research is that every individual conducts it in aRead MoreAnalysis of the Class Orientation to Psychology Essay1371 Words Ã |Ã 6 Pagespart of my college experience thus far. Although I came into college confidently declared as a psychology major, I didnÃ¢â¬â¢t really know what this meant or entailed prior to taking this course. This course taught me valuable information about myself, about the field of psychology, and about how I can mold those two together. All that IÃ¢â¬â¢ve learned this semester in Orientation to Psychology helped me to form a coherent and positive understanding of who I am and how this identity fits into the world ofRead MoreFacilitation of Learning1390 Words Ã |Ã 6 Pagessupport to students in practice, this is where students apply their knowledge, learn key skills and achieve the required competence for registration. Mentors are accountable to the NMC for their decision that students are fit for practice and that they have necessary knowledge, skills and competence to take on the role of registered nurse or midwife (NMC, 2008a). According to Morton Palmer (2000), mentors should display positive role modelling behaviours on duty. This gives the student the opportunityRead MoreHow I Have Learned As A Student Essay1426 Words Ã |Ã 6 Pagesthe various methods I have learned as a student in the introduction to research course. The skills and methods taught in this class have been presented through course textbooks, online articles and videos, and interaction with the professor. Other opportunities for learning the research skills and methods occurred through writing of papers, testing knowledge through quizzes, and through interactive discussion board threads and posts. In addition to acknowledging these learned methods, this paper
Wednesday, May 6, 2020
Agrarianism is defined as a political and social philosophy that emphasizes the importance of farming and the cultivation of plant life for man to lead a happier and fuller life. Thomas Jefferson, one of the chief proponents of Agrarian thought in American history, had mentioned its significance thus: Ã¢â¬Å"Those who labor in the earth are the chosen people of God, if He ever had a chosen people, whose breasts He has made His peculiar deposit for substantial and genuine virtue.Ã It is the focus in which He keeps alive that sacred fire, which otherwise might escape from the face of the earth (Ã¢â¬Å"AgrarianismÃ¢â¬ ). We will write a custom essay sample on Please refer to the Message Section. Agrarianism in Southern Literature or any similar topic only for you Order Now Ã¢â¬ Ã Agrarianism in Southern literature evolved at a time when the culture of the South was supposed to have been attacked by modernity.Ã To counter the negative impact of modernity on the Southern culture and traditions, a group of twelve traditionalist poets and writers published an Agrarian collection of essays in 1930: IÃ¢â¬â¢ll Take My Stand. The thesis of this manifesto was that the past rebukes the present for the latterÃ¢â¬â¢s dependency on machines as opposed to nature.Ã The South was seen as traditionally agricultural, and its people were understood as non-materialistic, religious, as well as well-educated. This viewpoint eventually took shape as an entire genre in Southern literature, as the writers and poets who had written for IÃ¢â¬â¢ll Take My Stand showed how Southern agrarianism could be expressed not only in poetry and essays, but also in biographies, novels, and works of literary and social criticism (MacKethan). Nevertheless, Southern agrarianism is considered an offshoot of Southern modernism, seeing that the subject of agrarian literature is alienation Ã¢â¬â a feeling of being out of place.Ã Moreover, almost all of the agrarian authors and poets are modern (Grammer). One of the famous Southern agrarians and a contributor to IÃ¢â¬â¢ll Take My Stand, Allen Tate has described his writing thus: Ã¢â¬Å"My attempt is to see the present from the past, yet remain immersed in the present and committed to it (Fain and Young 189).Ã¢â¬ Ã Even so, Southern modernism is considered an altogether separate genre (MacKethan). Influenced by modernism, Southern agrarianism is said to Ã¢â¬Å"produced the South (Kreyling 6).Ã¢â¬ Ã MacKethan writes that Southern agrarianism was largely a myth which the Southern agrarians Ã¢â¬â as the contributors to IÃ¢â¬â¢ll Take My Stand are called Ã¢â¬â had succeeded in propagating as reality. So, although Southern agrarianism was a myth, the writers and poets who had advocated agrarianism were successful in portraying the Southern peoples as non-materialist, lovers of nature.Ã They had managed to make the Southern peoples keep their focus on agrarianism to boot. Even so, as Kreyling maintains, the agrarian movement in Southern literature did not approach a unity of thought that the Southern agrarian writers and poets had claimed to be a mark of their traditional culture. Today, it is not possible to study the literature of the South without the agrarian model in its midst.Ã Moreover, despite its mythical nature, Southern agrarianism is said to present Ã¢â¬Å"an aesthetically gratifying world of pure formÃ¢â¬ in literature (Grammer 131). This Southern genre is a widely accepted one.Ã All the same, some of its proponents have left it altogether.Ã According to Ransom, Southern agrarianism was a constraint on his imagination. Robert Penn Warren, on the other hand, is known to have immersed himself completely in the philosophy of agrarianism (Grammer).Ã Regardless, agrarianism continues to be understood as an essential part of Southern literature, balancing the past with the present. Works Cited Ã¢â¬Å"Agrarianism.Ã¢â¬ Answers. 2007. 10 Nov 2007. http://www.answers.com/agrarianism. Fain, John Tyree, and Thomas Daniel Young (eds.). The Literary Correspondence of Donald Davidson and Allen Tate. Athens, GA: University of Georgia Press, 1974. Grammer, J. M. Ã¢â¬Å"Reconstructing Southern Literature.Ã¢â¬ American Literary History (Spring 2001), Vol. 13, No. 1, pp. 126-140. Kreyling, Michael. Inventing Southern Literature. Jackson: University Press of Mississippi, 1998. MacKethan, Lucinda. Ã¢â¬Å"Genres of Southern Literature.Ã¢â¬ Southern Spaces. 1 Aug 2005. 10 Nov 2007. http://www.southernspaces.org/contents/2004/mackethan/5c.v2.htm. Ransom, John Crowe. Ã¢â¬Å"Wanted: An Ontological Critic.Ã¢â¬ Selected Essays of John Crowe Ransom. Ed. Thomas Daniel Young and John Hindle. Baton Rouge: Louisiana State University Press, 1984, pp. 147-79. How to cite Please refer to the Message Section. Agrarianism in Southern Literature, Papers
Monday, May 4, 2020
There definitely exist pros and cons about interracial dating and or marriage. One of the major pros is that any person has the opportunity to choose any other person ill-relevant to their race. They have the opportunity to fall in love with and ultimately marry, then start a family with someone regardless of their race. This is the one and only consideration that I consider people should use when thinking of interracial relationships. We are all equal under Gods eyes, and we should have the same freedom of choice when considering our significant other. Sometimes friends or family can be against such decisions and be less than supportive. Often the rejection of close relatives happens due to the numerous stereotypes that still exist today. They can start looking for specific reasons or clues that motivated two people to become a couple or to get married. Families might disapprove because they want pure bred babies by being in anÃ OB 2 interracial relationship could destroy thousands of year old bloodlines. We will write a custom essay sample on Effects of interracial marriages or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Their inner circle may look down at them because they themselves may have discrimination or fear of other races Generations and age seem to affect the openness towards the interracial relations. Studies have shown that generational factors and influences are strong. When we are young we seem to be more open in our choices. The younger generations of people are more favorable to mixtures between the races. However, parents who are older often express disapproval of their own children marrying someone of another race. The study conducted by the Cornell University led to the conclusion that Ã¢â¬Å"although more young adults are dating and cohabiting with someone of a different race, the study found that interracial relationships areÃ considerably less likely than same-race relationships to lead to marriage, though this trend has weakened in recent years. Interracial couples also face some barriers that most other married people do not because they come from the same race or culture. There are external factors that create friction and annoyances in the relationships. Difference in cultures endures diverse ethnical, moral and value foundations that effect the perceptions of family, society and individual lifestyles. When such foundations are operating together with the foundations of different cultural roots, disagreements and problems can sometimes occur. Interracial relationships are often not intercultural ones because in the US people of various races are OB 3 sharing the same cultural background. Prejudice against interracial marriage is more obvious in some parts of the country than others. For members of interracial couples, this bias can be difficult to ignore. Interracial couples report feeling as though their family, friends, and society at large are more disapproving of their relationships than do same-race couples. Research indicates that couples who experience such a lack of social approval and acceptance for their relationships typically do not fare well. The more disapproval individuals perceive with respect to their relationships, the more likely they are to break-up in the future. Interracial couples who live in unsupportive environments often find it more challenging to stay together. America and the white race have come a long way since the first time they had brought slaves to this country. Now, African-American are guaranteed to same rights as everyone else and are treated the same. Society needs to consider the feelings of interracial couples. A person may not agree with interracial relationships, but they do not need to discriminate against them. Even today in the year 2013, society has its problems with interracial relationships. Through education and the way couples raise their children, the problem or problems facing interracial couples will diminish. Interracial marriages have become more and more popular as the years go on. However, our country is still very racially distinguished. The rate of interracial marriage has risen dramatically OB 4 in recent years, but support for these relationships still has a way to go. As attitudes become more favorable, interracial relationships are likely to strengthen and continue to increase in number.
Sunday, March 29, 2020
A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA) The WritePass Journal
A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA) Abstract A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA) ). This review aims to review the literature on coronary CT scanning and digital subtraction angiography, their clinical applications, techniques and comparative value in coronary artery assessment and diagnosis. Cardiac Digital subtraction angiography Coronary angiography is the conventional diagnostic procedure used in coronary artery disease. It is a minimally invasive technique, whereby a catheter is placed into the radial or femoral artery and is advanced through the arterial system to the coronary arteries. A contrast agent is then injected at the aortic root and allows visualization of the arteries using x-ray in real time at up to 30 frames per second. This allows a view of the extent, location and severity of coronary obstructive lesions such as atherosclerosis and enables prognostic indication (Miller et al., 2008). Coronary angiography also enables catheter placement either side of the lesion to assess pressure changes and determines the degree of flow obstruction (Miller et al., 2008). . Digital subtraction angiography (DSA) again works by introducing a contrast agent into the coronary arteries and taking x-rays in real time, however a pre image is taken by x-ray. This allows for the post images to be subtracted from the original mask image, eliminating bone and soft tissue images, which would otherwise overlie the artery under study (Hasegawa, 1987). Unlike conventional angiography, it is possible to conduct DSA via the venous system, through accessing the superior vena cava via the basillic vein (Myerowitz, 1982). This removes the risks associated with arterial cannulation (Mancini Higgins, 1985). The procedure can also be performed with a lower dose of contrast agent and be done more quickly therefore eliminating constraints of using too much contrast during a procedure (Myerowitz, 1982). Whilst DSA is the gold standard in arterial imaging of carotid artery stenosis (Herzig et al., 2004), the application of DSA to the coronary arteries is limited due to motion artefacts associated with each heartbeat and respiration (Yamamoto et al., 2009). There are numerous cardiac clinical applications of DSA, it can be used to assess coronary blood flow (Molloi et al., 1996), valvular regurgitation (Booth, Nissen DeMaria, 1985), cardiac phase (Katritsis et al., 1988), congenital heart shunts (Myerowitz, Swanson, Turnipseed, 1985), coronary bypass grafts and percutaneous coronary intervention outcomes (Katritsis et al, 1988; Guthaner, Wexler Bradley, 1985). However, others have suggested that the coronary arteries are not visualized well due to their small size, movement, their position overlying the opacified aorta and left ventricle, and confusion with other structures such as the pulmonary veins (Myerowitz, 1982). Cardiac CT Scanning Development of CT scanning in the 1990s enabled an increase in temporal resolution that was sufficient to view the beating heart, and they now provide a non-invasive technique for diagnostic and prognostic purposes. Cardiac CT scans have clinical applications that go beyond perfusion investigation, and can be used to assess structure and function of the heart (for example in electrophysiology disorders or congenital heart disease) due to its ability to provide anatomical detail (Achenbach Raggi, 2010). CT scans can be used to assess coronary artery disease with and without injection of contrast agent (Achenbach Raggi, 2010) by calcium scan or CT angiography. Coronary calcium CT scanning uses the evidence base that coronary artery calcium is a correlate of atherosclerosis (Burke et al., 2003) and is a strong prognostic predictor of the future development of coronary artery disease and cardiac events (Arad et al., 2000; Budoff et al., 2009; Achenbach Raggi, 2010). Calcium is easily depicted on CT scan due to its high CT attenuation, and is classified according to the Agatson score, which considers the density and area of the calcification (Hoffman, Brady Muller, 2003). Coronary CT angiography (CTA) allows visualization of the coronary artery lumen to identify any atherosclerosis or stenosis within the vessels. Patients are injected intravenously with a contrast agent and then undergo a CT scan. There are limitations regarding the suitability of patients for coronary CTA due to prerequisites of sinus rhythm, low heart rate and ability to follow breath-holding commands. Additionally, obesity presents a problem for patients that cannot fit into the scanner and affects the accuracy of the procedure. (Achenbach Raggi, 2010). Comparison of cardiac DSA and cardiac CT scanning The technical differences between cardiac DSA and cardiac CT scanning give rise to differences in the clinical indications for the procedures, their diagnostic efficacy and also different risks or relative benefits to the patients. Due to the nature of the images produced by coronary CTA and DSA, each lends itself to different indications for use. Whilst coronary DSA provides imaging of all aspects of perfusion, CTA used with contrast agent also provides this however has the additional advantage of being able to assess structure and function of the heart. Coronary CTA has been shown to have a high accuracy at detection and exclusion of coronary artery stenoses (Achenbach Raggi, 2010). In a multicentre trial conducted by Miller et al. (2008), patients underwent coronary calcium scoring and CT angiography prior to conventional invasive coronary angiography. The diagnostic accuracy of coronary CTA at ruling out or detecting coronary stenoses of 50% was shown to have a sensitivity of 85% and a specificity of 90%. This showed that coronary CTA was particularly effective at ruling out non-significant stenoses. Additionally, coronary CTA was shown to be of equal efficacy as conventional coronary angiography at identifying the patients that subsequently went on to have revascularisation via percutaneous intervention. This was shown by an area under the curve (AUC), a measure of accuracy of 0.84 for coronary CTA and 0.82 for coronary angiography. Miller et al.Ã¢â¬â¢s (2008) study included a large number of patients at different study sites, and additionally represented a large variety of clinical patient characteristics. The authorÃ¢â¬â¢s claim that these factors contribute to the strength and validity of the study findings, and suggest that in addition to using patients with clinical indications for anatomical coronary imaging, should be used as evidence that coronary CTA is accurate at identifying disease severity in coronary artery disease. Miller et al. (2008) did however,, find that positive predictive and negative predictive values of coronary CTA were 91% and 83% respectively and therefore suggested that coronary CTA should not be used in place of the more accurate conventional coronary angiography. A low positive predictive value (in relation to the prevalence of disease) was proposed to be due to a tendency to overestimate stenosis degree as well as the presence of artefacts leading to false positive interpretation (Achenbach Raggi, 2010). Other research providing comparison between coronary CTA and conventional coronary angiogram has highlighted variability in results. A meta-analysis conducted by Gorenoi, Schonermark and Hagen (2012) investigated the diagnostic capabilities of coronary CTA and invasive coronary angiography using intracoronary pressure measurement as the reference standard. The authors found that CT coronary angiography had a greater sensitivity than invasive coronary angiography (80% vs 67%), meaning that coronary CTA was more likely to identify functionally relevant coronary artery stenoses in patients. Despite this,, specificity of coronary CTA was 67%, compared to 75% in invasive coronary angiography, meaning that the technique was less effective at correctly excluding non-diagnoses than invasive coronary angiogram. This research appears to contradict the power of cardiac CTA at excluding diagnoses of coronary artery stenosis as suggested by Miller et al. (2008), he study did combine evidence from over 44 studies to provide their results and therefore had a large statistical power. The authors interpret the results in light of the clinical relevance of cardiac imaging, suggesting that patients with a higher pretest possibility of coronary heart disease will likely require invasive coronary angiography for revascularisation indicating that coronary CTA may be a helpful technique in those patients with an intermediate pre-test probability of coronary heart disease that will therefore not require invasive angiography. Goldberg et al. (1986) investigated the efficacy of DSA in comparison to conventional coronary angiography in 77 patients. They found that the two angiograms agreed within one grade of severity in 84% of single cases and 90% of multiple cases, identifying both patent and lesioned arteries. The results led the authors to conclude that there was no significant difference between the two methods and that DSA could be used in selective coronary angiography to find results comparable to that of conventional angiography. In addition to being a small study into the efficacy of DSA, the study also had several sources of inherent variability that should be considered when interpreting the results. These included differing sizes of digital imaging screen and non-use of calipers, meaning that the interpretation of the images could vary throughout the study. The authors also suggest that whilst showing strong support for the use of DSA in coronary artery disease, the technique may not actually p ermit better prognostic determinations or clinical judgements that are better than conventional angiography, and therefore the further implementation of the techniques may not be founded or necessitated. More recently, there has been further research looking at the effectiveness of DSA as a way of measuring coronary blood flow. Whilst motion artefacts have proven a problem in lots of past research (Marinus, Buis Benthem, 1990; Hangiandreou, 1990), recent research has developed methods to minimise these. Moilloi and colleaues (1996) showed that using a motion-immune dual-energy digital subtraction angiography, absolute volumetric coronary blood flow could be measured accurately and thus provide an indication of the severity of any arterial stenosis.This may provide further suggestion for clinical implementation of DSA. Although these studies provide evidence for the efficacy of cardiac DSA and CTA, they often make comparisons to conventional angiography. This is useful as a baseline comparison, however it is difficult to make comparisons between the two procedures directly due to less available evidence making direct comparisons. Lupon-Roses et al. (1985) conducted a study investigating both coronary CTA and venous DSA. The study looked at the efficacy of both techniques at diagnosing patency of coronary artery grafts compared to the control conventional angiography. CT was shown to diagnose 93% of the patent grafts and 67% of the occluded grafts whereas DSA correctly diagnosed 98% and 100% of patent and occluded grafts respectively. Interestingly, the DSA picked up the 11 grafts that were misdiagnosed by CTA and the CTA picked up the 2 grafts misdiagnosed by the DSA. This data may suggest that individually, DSA has a better profile for diagnosis of coronary artery occlusion, however if the two procedures are used in combination exclusion of patent arteries and diagnosis of occluded arteries would be effective (Lupon-Roses et al., 1985). Coronary DSA and CTA are both non-invasive procedures (unlike the conventional coronary angiography where a wire is placed in the coronary vasculature). With the only invasive part of the procedure being the injection of the contrast material into a vein. This presents a significant advantage to both procedures over that of conventional angiography, and may even permit investigation on an outpatient basis (Meaney et al., 1980). Similarly, both DSA and coronary CTA are favoured because of their intravenous approach, eliminating the risks of bleeding or arterial injury from an intra-arterial catheterization and being able to be used in those with limited arterial access. However, although the intravenous approach used in cardiac DSA makes it favourable, it does lead to difficulty with visualisation of the coronary arteries due to the overlying iodinated pulmonary and cardiac structures (Mancini Higgins, 1985). Therefore,, intra-arterial DSA is also sometimes used (Yamamoto et al., 200 9). As with all CT scanning, coronary CTA carries with it a dose of ionizing radiation (Brenner Hall, 2007). Studies have estimated that for diagnostic CT scanning, patients are on average exposed to 12mSv of radiation during the procedure, the equivalent of 600 x-rays (Hausleiter et al., 2009). Estimates of radiation doses associated with conventional coronary angiography are lower than that of coronary CTA at 7mSv (Einstein et al., 2007). Additionally, DSA technique reduces the radiation dose from that of conventional coronary angiography as the vessels are visualised more clearly (Yamamoto et al., 2008). The dangers of radiation exposure are increased risk of developing cancer, skin injuries and cateracts (Einstein et al., 2007). It is therefore important that the benefits of conducting the procedure greatly outweigh the risk of radiation exposure. CT calcium scanning provides a low radiation dose at around 1mSv (Hunold et al., 2003). Cardiac CT calcium scanning does not require administration of a contrast agent, unlike in coronary CTA and DSA that use iodine based contrast agents. The risks associated with contrast agent include nephrotoxicity and risks of hives, allergic reactions and anaphylaxis (Maddox, 2002). The amount of contrast agent used is partly dependent on the length of the procedure and how clearly the arteries can be visualised. For this reason, both cardiac CTA and DSA use less contrast agent that conventional coronary angiography (Brant-Zawadzki, et al., 1983). CT calcium scanning of the coronary arteries is therefore recommended in those with less likelihood of coronary artery disease (NICE, 2010). Both coronary CTA and DSA require interpretation by trained physicians, and the importance of training and achieving intra-rater reliability should not be underestimated (Pugliese et al., 2009). Conclusion Overall, both coronary CT and DSA have been demonstrated as effective procedures for the imaging of the coronary arteries in CAD (Achenbach Raggi, 2010; Miller et al., 2008; Moilloi et al., 1996; Goldberg et al., 1986). Whilst cardiac CT scanning does provide a wider range of clinical applications, allowing assessment of perfusion as well as cardiac structure and function (Achenbach Raggi, 2010), coronary DSA has many applications that allow assessment of coronary blood flow (Molloi et al., 1996; Katritsis et al, 1988; Booth, Nissen DeMaria, 1985; Guthaner, Wexler Bradley, 1985; Myerowitz, Swanson, Turnipseed, 198). Both cardiac DSA and CTA procedures have their advantages. As non-invasive procedures, these techniques pose less risk to patients, and enable the possibility of outpatient investigation, to be used to rule out diagnoses and to avoid inappropriate invasive coronary angiogram (Gorenori et al., 2012). Additionally, intravenous access is preferential to arterial cannulation for the contrast infusion, removing the risks associated with bleeding or intra-arterial injury. Cardiac DSA exposes the patient to a lower dose of radiation that coronary CTA (Hausleiter et al., 2009; Yamamoto et al., 2008; Einstein et al., 2007), which is beneficial at reducing the risk of genetic mutations and cancer. Cardiac CTA and DSA also have their common disadvantages. The use of contrast agent may present side effects for the patient including kidney damage and risk of allergic reactions and anaphylaxis (Maddox, 2002). For this reason, calcium CT scanning can be useful in patients that are not at high likelihood of coronary artery disease (NICE, 2010b). Additionally, both cardiac DSA and CTA are subject to motion artefacts from respiration and heart beats, which can cause difficulties with interpretation (Achenbach Raggi, 2010; Yamamoto et al., 2009). In the case of cardiac CTA, this excludes a subset of patients that are unable to follow commands and those who have high heart rates. Overall, cardiac CTA and cardiac DSA are effective, non-invasive imaging techniques for assessment of coronary artery disease. Whilst they are not the gold standards in cardiac monitoring, they can provide important diagnostic information without exposing patients to the risks of invasive angiography. Due to this, their use should be weighted against clinical need, the risks of the procedures, and the suitability of the patient. Interpretation of cardiac CTA and DSA imaging should be by trained individuals. References Achenbach, S., Raggi, P. (2010) Imaging of coronary atherosclerosis by computed tomography. European Heart Journal. 31:1442 Arad, Y., Spadaro, L. A., Goodman, K., Newstein, D., Guerci, A. D. (2000). Prediction of coronary events with electron beam computed tomography.Journal of the American College of Cardiology,Ã 36(4), 1253-1260. Booth, D. C., Nissen, S., DeMaria, A. N. (1985). 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Task force# 2- what is the pathologic basis for new atherosclerosis imaging techniques?.Ã Journal of the American College of Cardiology,41(11), 1874-1886. Einstein, A. J., Moser, K. W., Thompson, R. C., Cerqueira, M. D., Henzlova, M. J. (2007). Radiation dose to patients from cardiac diagnostic imaging.Circulation,Ã 116(11), 1290-1305. Goldberg HL, Moses JW, Fisher J, Tamari I, Borer JS (1986). Diagnostic accuracy of coronary angiography utilizing computer-based digital subtraction methods; Comparison to conventional cineangiography. Chest 90, 793Ã¢â¬â797, Gorenoi, V., SchÃ ¶nermark, M. P., Hagen, A. (2012). CT coronary angiography vs. invasive coronary angiography in CHD.Ã GMS health technology assessment,Ã 8,Ã Doc02-Doc02.. Guthaner, D. F., Wexler, L., Bradley, B. (1985). Digital subtraction angiography of coronary grafts: optimization of technique.Ã American journal of roentgenology,Ã 145(6), 1185-1190. Hacker, M., Jakobs, T., Hack, N., Nikolaou, K., Becker, C., von Ziegler, F., Tiling, R. (2007). Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina.Ã European journal of nuclear medicine and molecular imaging,34(1), 4-10. Hangiandreou N. J.Ã (1990) Coronary Blood Flow Measurement Using Digital Subtraction Angiography and First Pass Distribution Analysis. Madison, Wis: University of Wisconsin-Madison; Thesis. Hasegawa, B. (1987). Physics of Medical X-Ray Imaging 2nd Edition. Medical Physics Publishing Corporation. Hausleiter, J., Meyer, T., Hermann, F., Hadamitzky, M., Krebs, M., Gerber, T. C., Achenbach, S. (2009). Estimated radiation dose associated with cardiac CT angiography.Ã Jama,Ã 301(5), 500-507. Herzig, R., BuÃ â¢val, S., KÃ â¢upka, B., Vlachov, I., Urbnek, K., MareÃ ¡, J. (2004). Comparison of ultrasonography, CT angiography, and digital subtraction angiography in severe carotid stenoses.Ã European Journal of Neurology,Ã 11(11), 774-781. Brant-Zawadzki, M., Gould, R., Norman, D., Newton, T. H., Lane, B. (1983). Digital subtraction cerebral angiography by intraarterial injection: comparison with conventional angiography.Ã American Journal of Roentgenology,Ã 140(2), 347-353. Hoffmann, U., Brady, T.J., Muller, J. (2003). Cardiology patient page. Use of new imaging techniques to screen for coronary artery disease. Circulation 108 (8): e50Ã¢â¬â3. Hunold, P., Vogt, F. M., Schmermund, A., Debatin, J. F., Kerkhoff, G., Budde, T., Barkhausen, J. (2003). Radiation Exposure during Cardiac CT: Effective Doses at MultiÃ¢â¬âDetector Row CT and Electron-Beam CT 1.Radiology,Ã 226(1), 145-152. Katritsis, D., Lythall, D.A., Cooper, I.C., Crowther, A., Webb-Peploe, M.M. (1988) Assessment, of coronary angioplasty: Comparison of visual assessment, handÃ¢â¬ held caliper measurement and automated digital quantitation.Ã Catheterization and cardiovascular diagnosis,Ã 15(4), 237-242. Kaufmann, P. A., Gnecchi-Ruscone, T., Schfers, K. P., LÃ ¼scher, T. F., Camici, P. G. (2000). Low density lipoprotein cholesterol and coronary microvascular dysfunction in hypercholesterolemia.Ã Journal of the American College of Cardiology,Ã 36(1), 103-109. Liu, J. L. Y., Maniadakis, N., Gray, A., Rayner, M. (2002). The economic burden of coronary heart disease in the UK.Ã Heart,Ã 88(6), 597-603. LupÃ ³n-RosÃ ©s, J., Domingo, E., Marinez-Vzquez, J. M., LÃ ³pez-Moreno, J. L., MontaÃ ±, J., Permanyer-Miralda, G., Soler-Soler, J. (1985). Direct non-invasive techniques for assessing coronary bypass graft patency.Ã The International Journal of Cardiac Imaging,Ã 1(3), 181-188. Maddox, T. G. (2002). Adverse reactions to contrast material: recognition, prevention, and treatment.Ã American family physician,Ã 66(7), 1229. Mancini, J. G. B., Higgins, C. B. (1985). Digital subtraction angiography: a review of cardiac applications.Ã Progress in cardiovascular diseases,Ã 28(2), 111-141. Marinus, H., Buis, B., Van Benthem, A. (1990) Pulsatile coronary flow determination by digital angiography.Ã International Journal of Cardiac Imaging, 5, 173-182 McClure, K. H., McGivern, J. P., Stultz, M. R., Whitehurst, T. K. (2009).Ã U.S. Patent No. 7,481,759. Washington, DC: U.S. Patent and Trademark Office. Meaney, T. F., Weinstein, M. A., Buonocore, E., Pavlicek, W., Borkowski, G. P., Gallagher, J. H., Maclntyre, W. J. (1980, August). Digital subtraction angiography of the human cardiovascular system. InÃ Application of Optical Instrumentation in Medicine VIIIÃ (pp. 272-278). International Society for Optics and Photonics. Miller, J. M., Rochitte, C. E., Dewey, M., Arbab-Zadeh, A., Niinuma, H., Gottlieb, I., Lima, J. A. (2008). Diagnostic performance of coronary angiography by 64-row CT.Ã New England Journal of Medicine,Ã 359(22), 2324-2336. Molloi, S., Ersahin, A., Tang, J., Hicks, J., Leung, C. Y. (1996). Quantification of volumetric coronary blood flow with dual-energy digital subtraction angiography.Ã Circulation,Ã 93(10), 1919-1927. Myerowitz, P. D. (1982). Digital subtraction angiography: present and future uses in cardiovascular diagnosis.Ã Clinical cardiology,Ã 5(12), 623-629. Myerowitz, P. D., Swanson, D. K., Turnipseed, W. D. (1985). Applications of digital subtraction angiography in cardiovascular diagnosis.Ã The Surgical clinics of North America,Ã 65(3), 423-437. National Institute for Health and Care Excellence. (2010a). Unstable angina and NSTEMI: The early management of unstable angina and non-ST-segment-elevation myocardial infarction. CG94. London: National Institute for Health and Care Excellence. National Institute for Health and Care Excellence. (2010b). Unstable angina and NSTEMI: Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. CG95. London: National Institute for Health and Care Excellence. Pugliese, F., Hunink, M. M., Gruszczynska, K., Alberghina, F., MalagÃ ³, R., van Pelt, N., Krestin, G. P. (2009). Learning curve for coronary CT angiography: what constitutes sufficient training?.Ã Radiology,Ã 251(2), 359. Yamamoto, M., Okura, Y., Ishihara, M., Kagemoto, M., Harada, K., Ishida, T. (2009). Development of digital subtraction angiography for coronary artery.Ã Journal of digital imaging,Ã 22(3), 319-325.
Saturday, March 7, 2020
Avoiding the Passive Voice in Spanish One of the most common mistakes made by beginning Spanish students who have English as a first language is to overuse passive verb forms. Sentences with passive verbs are very common in English, but in Spanish they arent used very much- especially in everyday speech. Key Takeaways: Spanish Passive Voice Although Spanish has a passive voice, it isnt used as much in Spanish as it is in English.One alternative to the passive voice is to turn it into the active voice. Either explicitly state the subject or use a verb that allows the subject to be implied rather than stated.Another common alternative is to use reflexive verbs. What Is the Passive Voice? The passive voice involves a sentence construction in which the performer of the action isnt stated, and in which the action is indicated by a form of to be (ser in Spanish) followed by a past participle, and in which the subject of the sentence is the one acted upon. If that isnt clear, look at a simple example in English: Katrina was arrested. In this case, it isnt specified who performed the arrest, and the person arrested is the subject of the sentence. The same sentence could be expressed in Spanish using the passive voice: Katrina fue arrestada. But not all English sentences using the passive voice can be translated into Spanish the same way. Take, for example, Jose was sent a package. Putting that sentence in a passive form in Spanish doesnt work. JosÃ © fue enviado un paquete just doesnt make sense in Spanish; the listener might think at first that Jose was sent somewhere. Also, Spanish has quite a few verbs that simply arent used in the passive form. And still others arent used passively in speech, although you may see them in journalistic writing or in items translated from English. In other words, if you want to translate an English sentence using a passive verb to Spanish, youre usually best off coming up with a different way. Alternatives to the Passive Voice How, then, should such sentences be expressed in Spanish? There are two common ways: recasting the sentence in the active voice and using a reflexive verb. Recasting in the passive voice: Probably the easiest way to translate most passive sentences in Spanish is to change them to the active voice. In other words, make the subject of the passive sentence the object of a verb. One reason for using a passive voice is to avoid saying who is performing the action. Fortunately, in Spanish, verbs can stand alone without a subject, so you dont necessarily have to figure out who is performing the action to revise the sentence. Some examples: Passive English: Roberto was arrested.Active Spanish: Arrestaron a Roberto. (They arrested Roberto.)Passive English: The book was bought by Ken.Active Spanish: Ken comprÃ ³ el libro. (Ken bought the book.)Passive English: The box office was closed at 9.Active Spanish: CerrÃ ³ la taquilla a las nueve. Or, cerraron la taquilla a las nueve. (He/she closed the box office at 9, or they closed the box office at 9.) Using reflexive verbs:Ã The second common way in which you can avoid the passive voice in Spanish is to use a reflexive verb. A reflexive verb is one in which the verb acts on the subject. An example in English: I saw myself in the mirror. (Me vi en el espejo.) In Spanish, where the context doesnt indicate otherwise, such sentences are often understood in the same way as are passive sentences in English. And like passive forms, such sentences dont clearly indicate who is doing the action. Some examples: Passive English: Apples (are) sold here.Reflexive Spanish:Ã AquÃ se venden las manzanas. (Literally, apples sell themselves here.)Passive English: The box office was closed at 9.Reflexive Spanish: Se cerrÃ ³ la taquilla a las nueve. (Literally, the box office closed itself at 9.)Passive English: A cough isnt treated with antibiotics.Reflexive Spanish: La tos no se trata con antibiÃ ³ticos. (Literally, the cough doesnt treat itself with antibiotics.) Some of the sample sentences in this lesson could be understandably translated to Spanish in the passive form. But native Spanish speakers dont normally speak that way, so the translations on this page would usually sound more natural. Obviously, you wouldnt use the literal translations above in translating such Spanish sentences to English! But such sentence constructions are very common in Spanish, so you shouldnt shy away from using them.
Wednesday, February 19, 2020
Liberalisation of the financial sector iceland - Essay Example The banks in general did not have to worry too much about the competition and customer satisfaction philosophies as the banks had been working under national regulation as part of the public sector. Earlier, Icelandic banks did have international offices to support the domestic customers, e.g. Kaupthing bank's filial in Luxembourg and New York; however most of the business was domestic orientated. Today 70% of profits of Kaupthing bank, the third largest in Iceland, are made outside Iceland - a significant change (Annual rapport 2006, Kaupthing Bank p4). Iceland is an island with many small isolated towns; therefore the cost of having many filial is considerably high. But in view of the local needs, it was a necessity (Jensen 2003). The liberalization process has contributed immensely towards expanding the domestic financial markets. Today the major credit institutions such as pension funds and house founds, which used to be separate units earlier, are today merged with the new commercial banks (sector rapport OECD p43). Therefore the banks have now changed from being mere saving banks to financial institutions (FIs) with a wide portfolio of services from lending money out to holding pensions. Though government still controls the larger household funds, whose job is to lend out money for buying houses. This is seen as a secure investment. In addition it also provides short-term credit for households and businesses as is provided by commercial banks. The longer term financing for both business and housing is largely provided by government investment funds drawn from their resources in private sector pension schemes and foreign borrowings. The Icelandic financial institutions are divided into three main groups, banks, pension funds and government credit funds. The government credit funds can be further divided into 3 minor groups, (insurance, leasing and mutual funds). Looking on the graph at appendix 5 we can see that the pension funds and the banks have the biggest share. The foreign sector who supplies outstanding credit to government and its credit funds -also figures as a dominating group. Controlling of the financial market doing liberalizing period Before the liberalisation process, the government was in control of most of the financial institutions in Iceland including the banking sector. The sectors were missing out on reforms process and modern agreements. The financial sector had more in common with a regulated Pan Atlantic country than the rest of north Europe. This was also due to a smaller economy where the government wanted to protect it against foreign exchange speculations dealers. Iceland has undergone through several years' of weak economy with a high rate of inflation and strong devaluation of its currency. Some of the Icelandic Banks also suffered huge losses while being a part of the public sector. Owing to such losses the Islandsbanki became insolvent in 1995 (Jensen 2006 p7). Banking sector Today, there are 24 smaller 'saving banks' and 3 'major banks' in the financial sector in Iceland. The three banks, Kaupthing Bank, Landsbanki Bank and Glitnir Bank are dominating the