Effect

Sentence Connectors Sentences Showing Cause/Effect Sentence connectors are words and expressions that interface sentences to help with comprehension. Sentence connectors are otherwise called connecting language. This connecting language can be utilized to arrange what you need to state, show resistance, give explanation, etc. In numerous punctuation books, you will discover data about sentence connectors when finding out about subjecting conjunctions, planning conjunctions, etc. Here are sentence connectors that show circumstances and logical results in composed English.â Kind of Connector Connector(s) Models Planning conjunctions for (cause), so (impact) Experts can in some cases be incredibly anxious, for their positions are now and again rather stressful.The specialist chose a subsequent feeling was required, so Tom was sent to an eye authority. Subjecting conjunctions since, since, as Since significant level positions are now and again rather distressing, experts can once in a while be incredibly impatient.Ive chosen to return to class on the grounds that Ive consistently needed to contemplate philosophy.As the gathering started late, the CEO went legitimately to his introduction on last quarters deals. Conjunctive verb modifiers in this manner, thus, therefore Significant level positions are on occasion rather unpleasant. In this way, experts can once in a while be amazingly impatient.Susan appreciated investing her free energy at the theater. Thus, she chose to get away in London so as to go to plays.The lease has expanded radically in the course of recent years. Thus, weve chose to move to a more affordable city. Relational words due to, due to, because of Because of the distressing idea of significant level positions, experts can once in a while be very impatient.Albert gone home early due to his meeting with his doctor.Many understudies burn through at least two hours playing computer games every day. Therefore, their evaluations endure and they once in a while need to rehash classes. Progressively About Sentence Connectors When you have aced the essentials of right use in composed English, you will need to communicate in increasinglyâ complex ways. Probably the most ideal approaches to improve your composing style is to utilize sentence connectors. Sentence connectors are utilized to communicate connections among thoughts and to consolidate sentences. The utilization of these connectors will add advancement to your composing style. Sentence connectors can accomplish more than show cause and result. Here is a short outline with instances of each kind of sentence connector and connections to more data. At the point when you need to give extra data: Not just have I not completed my work on the report, however I likewise need to start take a shot at one months from now introduction in New York which is very important.Mark might want to concentrate on his investigations one year from now. Likewise, he needs to search for a temporary job to improve his resume to help him in his future quest for new employment. Some sentence connectors demonstrate resistance to an ideaâ or show shock circumstances. Mary requested one more week to finish the task despite the fact that she had just gone through three weeks in preparation.Despite the monetary development of the previous eight years, most white collar class residents are having troublesome getting by.  Standing out data from connectors encourages you show the two sides of any contention: From one viewpoint, we havent put resources into foundation in the course of recent decades. Then again, charge incomes are at the most reduced in years.Unlike my French class, schoolwork in my business course is testing and interesting.â Subjecting conjunctions, for example, if or except if express conditions in different circumstances. On the off chance that we dont finish the undertaking soon, our manager will be extremely vexed and fire everyone!She chose to complete school in New York. Something else, shed need to move back home and live with her folks. Looking at thoughts, objects , and individuals is another utilization for these connectors: Similarly as Alice might want to go to workmanship school, Peter needs to go to a music conservatory. The showcasing office feels we need another include battle. Correspondingly, innovative work feel our items need a new methodology.

A Book Review of The Kissing Hand by Audrey Penn

A Book Review of The Kissing Hand by Audrey Penn Since it was first distributed in 1993, The Kissing Hand by Audrey Penn has given consolation to youngsters managing troublesome changes and circumstances. While the focal point of the image book is on fears about beginning school, the consolation and solace the book gives can be applied to a wide range of circumstances. Outline of The Kissing Hand The Kissing Hand is the narrative of Chester Raccoon, who is alarmed to tears at the idea of beginning kindergarten and being ceaselessly from his home, his mom and his standard exercises. His mom consoles him pretty much all the beneficial things he will discover at school, including new companions, toys, and books. The best part is that she reveals to Chester that she has a brilliant mystery that will cause him to feel at home at school. Its a mystery, went down to Chesters mother by her mom and to her mom by Chesters extraordinary grandma. The name of the mystery is the Kissing Hand. Chester needs to know more, so his mom shows him the mystery of the Kissing Hand. In the wake of kissing Chesters palm, his mom lets him know, Whenever you feel forlorn and need a bit of cherishing from home, simply press your hand to your chest and think, Mommy adores you. Chester is consoled to realize that his moms love will be with him any place he goes, even kindergarten. Chester is then motivated to give his mom a kissing hand by kissing her palm, which makes her upbeat. He at that point joyfully heads out to class. The story is marginally more grounded than the representations, which while bright, are not too executed as they could be. Be that as it may, children will see Chester as engaging in both the story and the representations. Toward the finish of the book, there is a page of little red heart-formed stickers that have the words The Kissing Hand imprinted on every one of them in white. This is a decent touch; instructors and advocates can give out the stickers subsequent to perusing the story to a class or guardians can utilize one at whatever point a youngster needs consolation. As indicated by her site, Audrey Penn was motivated to compose The Kissing Hand because of something shed seen and something she did accordingly. Shed seen a raccoon kiss the palm of her offspring, and afterward the fledgling put the kiss all over. At the point when Penns little girl was terrified about beginning kindergarten, Penn consoled her with a kiss to the palm of her girls hand. Her little girl was console, realizing the kiss would go with her any place she went, including school. About the Author, Audrey Penn After her profession as a ballet dancer reached a conclusion when she turned out to be sick with adolescent rheumatoid joint inflammation, Audrey Penn found another vocation as an essayist. Be that as it may, she started composing a diary when she was in the fourth grade and kept composition as she was growing up. Those early works turned into the reason for her first book, Happy Apple Told Me, distributed in 1975. The Kissing Hand, her fourth book, was distributed in 1993 and has become her most notable book. Audrey Penn got the Educational Press Association of Americas Distinguished Achievement Award for Excellence in Educational Journalism for The Kissing Hand. Penn has expounded on 20 books for youngsters. Taking all things together, Audrey Penn has composed 6 picture books about Chester Raccoon and his mom, each concentrating on an alternate circumstance that can be hard for a youngster to manage: A Pocket Full of Kisses (another infant sibling), A Kiss Goodbye (moving, setting off to another school), Chester Raccoon and the Big Bad Bully (managing a domineering jerk), Chester Raccoon and the Acorn Full of Memories (the passing of a companion) and Chester the Brave (beating fears), She likewise composed A Bedtime Kiss for Chester Raccoon, a load up book managing sleep time fears. Regarding why she expounds on creatures, Penn clarifies, Everyone can relate to a creature. I never need to stress over partiality or offending on the off chance that I utilize a creature rather than a person.â About the Illustrators, Ruth E. Harper and Nancy M. Hole Ruth E. Harper, who was conceived in England, has a foundation as a craftsmanship educator. Notwithstanding showing The Kissing Hand alongside Nancy M. Break, Harper showed Penns picture book Sassafras. Harper utilizes an assortment of media in her work, including pencil, charcoal, pastel, watercolor, and acrylic. Craftsman Nancy Leak, who lives in Maryland, is known for her printmaking. Barbara Leonard Gibson is the artist of all of Audrey Penns other picture books and board books about Chester Raccoon.â Audit and Recommendation The Kissing Hand has given a great deal of solace to terrified youngsters throughout the years. Numerous schools will peruse it to another kindergarten class to facilitate their feelings of dread. By and large, youngsters are as of now acquainted with the story and the possibility of the kissing hand truly reverberates with youthful ones. The Kissing Hand was initially distributed in 1993 by the Child Welfare League of America. In the foreword to the book, Jean Kennedy Smith, originator of Very Special Arts, composes, The Kissing Hand is a story for any youngster who faces a troublesome circumstance, and for the kid inside every one of us who now and again needs consolation. This book is ideal for kids 3 to 8 years of age who need soothing and consolation. (Tanglewood Press, 2006.) More Recommended Picture Books In the event that you are searching for sleep time stories for small kids that are consoling, Amy Hests Kiss Good Night, showed by Anita Jeram, is a decent suggestion, as is Goodnight Moon by Margaret Wise Brown, with delineations by Clement Hurd. For small kids stressed over beginning school, the accompanying picture books will help facilitate their feelings of trepidation: First Grade Jitters by Robert Quackenbush, with delineations by Yan Nascimbene, and Mary Ann Rodmans First Grade Stinks! represented by Beth Spiegel. Sources: Audrey Penns site, Tanglewood Press

Fall Transfer Update - UGA Undergraduate Admissions

Fall Transfer Update - UGA Undergraduate Admissions Fall Transfer Update Although I cannot give daily updates on what is happening with Fall transfer decisions, I will try to post a weekly update either on Thursday or Friday about the progress our office has made in reviewing Fall files. I will not be able to tell you when your file will be reviewed, what date is being reviewed (because it depends upon when a student applied, when the initial transcript was received, when the last transcript was received, and if we have all needed materials, etc.), or why an applicant has or has not heard yet. Our focus is on reviewing files, and we generally can make about 50-75 decisions a day, depending on how complicated the files are. As of this morning, we have roughly 2,500 fall transfer applications, and my estimate is that about 400 of these applications are incomplete (no transcript, missing transcript, out of date transcript, etc.). We have made decisions on about 750-800 files so far, and fall transfer decisions are our main focus at this time. At times, we may be pulled away for a day or so due to other issues, such as updated summer transfer materials right before summer orientation, or a furlough day (one is scheduled for 4/30). Please bear with us as we move forward with these applications, as we are working as quickly as possible to make decisions on these files.

Cutaneous Tuberculosis Disease - Free Essay Example

Sample details Pages: 19 Words: 5677 Downloads: 10 Date added: 2017/06/26 Category Health Essay Type Narrative essay Did you like this example? CHAPTER -1 CUTANEOUS TUBERCULOSIS INTRODUCTION: In this innovative world while progress in medicine has helped up to deal with many diseases Tuberculosis and Cutaneous Tuberculosis is still a challenge for doctors. A resurgence of Cutaneous Tuberculosis in areas of high HIV incidence, drug resistant present in patients with pulmonary tuberculosis and in immunosupressed patients are the main challenges for clinicians. (6) Cutaneous TB is caused by Mycobacterium tuberculosis, Mycobacterium bovis, Bacillus Calmette-Guerin (BCG) vaccinations and the Tuberculids whose pathogenesis is poorly understood. Don’t waste time! Our writers will create an original "Cutaneous Tuberculosis Disease" essay for you Create order Cutaneous TB is very variable in its clinical presentation, significance prognosis. Factors which effect on variability are: The pathogenesity of the organism involved. The Previous treatment given. The Immune status of the patients which can be related to the presence of Acquired Immunodeficiency Syndrome (AIDS) or Immunosuppressive therapy. The Port of infection. Any Local factors like, the recent Trauma, the lymphatic drainage, the vascularity of area and the proximity to lymph nodes). PREVALANCE: Thirty years ago it was assumed world wide that tuberculosis would be eradicated in the developed countries, as its incidence increased only on by average 6 % in the United States and 10% in Europe between the years 1953 and 1985. However, in 1983 tuberculosis was declared a global emergency by the world Health Organization because of a sharp increase in incidence. (9) Among infectious diseases, Tuberculosis is an important cause of death. Tuberculosis was responsible for 6% of deaths worldwide. Global prevalence of TB currently is greater than 32%. More than 50% of new patient occurrences were in 5 Asian countries, i.e. India (largest worldwide patient load), China, Indonesia, Bangladesh, and Pakistan(ref ?) The current global burden of Tuberculosis is mind boggling. In 1997, the incidence of new Tuberculosis patients approached 8 million in addition to more than 16 million patients already diagnosed. Around 2 million people died of Tuberculosis in 1997 with a global fatality rate of 23%, fatality rates exceed 50% in some African countries in which there is a high HIV incidence. Approximately 8% of tuberculosis patients are HIV infected. (2) Prevalence of tuberculosis infection in 1985, 1995 and 2005 (10) Prevalence of tuberculosis has increased between 1985 and 2005.According to the World Health Organization case reports statistics, in 1985 there were around 3 million patients of tuberculosis of all types with the highest no of cases in Asia and Africa. In Asia the highest numbers of cases were in India, Pakistan, China, Philippines, Bangladesh, Afghanistan and Vietnam. In Africa the highest number of case were in Ethiopia, Nigeria, South Africa, Congo, Morocco and Tanzania. (10) During the last two decades the number of cases increased all over the world. In 1995 the total number of cases increased to 4.6 million and in 2005 to 7.5 million worldwide. In Asia in 2005 the highest numbers of cases were in India, China Pakistan. In Africa in 2005 the highest numbers of cases were in South Africa, Ethiopia Congo. (10) There is an increasing rate of tuberculosis in the developing countries is approximately 500/100,000/y. Great alarm has been the progressive increase in numbers of strains of tuberculosis that are resistant to antibiotics. Since 1984, that incidence of extra pulmonary tuberculosis has increased at even faster rate than that of pulmonary tuberculosis and is considered to be a diagnostic criterion in the case definition for AIDS. Because immunocompromised individual are at increased risk of extra pulmonary tuberculosis, so dermatologist are renewing their historic role in the diagnosis of cutaneous lesions of tuberculosis. (11) EPIDEMIOLOGY: Epidemiological analysis is used to detect the changing trends in the incidence and prevalence of mycobacterial disease in the community. The main objectives of these methods are to determine the natural behavior of disease and factors which affect his behavior and to calculate future trend if possible to help in the design of any control measures and to assess the usefulness of these measure.(8) Even though 1 of 3 individuals on this planet is infected with tubercle bacillus, the incidence of Cutaneous TB appears low. In areas such as India or China where TB prevalence is high, cutaneous manifestations of TB (overt infection or Tuberculids) are found in less than 0.1% of persons seen in dermatology clinics. The frequency of patients with Cutaneous Tuberculosis seen between 1980 and 1993 in a hospital dermatology clinic in Madrid was 16 per 10,304 which was 0.14%. In a ten year retrospective survey of patients seen in governmental dermatology clinics in Hong Kong between 1983 and 1992, the detected incidence of Cutaneous Tuberculosis among patients was 179 per 267,089 which was 0.07%. Among patients with Cutaneous Tuberculosis only15% had classic Cutaneous Tuberculosis and 85% had tuberculids. In that classical cutaneous tuberculosis approximately 5% had lupus vulgaris, 5% had Tuberculosis Verrucosa cutis and 5% had scrofuloderma. (2) In a tertiary-care hospital in northern India, 0.1% of dermatology patients seen between 1975 and 1995 had Cutaneous Tuberculosis. Lupus vulgaris was the most common manifestation around 55%, followed by scrofuloderma 27%, TB Verrucosa cutis 6%, tuberculous gumma 5%, and tuberculids occurred in 7%. (2) FREQUENCY: USA: In the United States, tuberculosis cases decreased from 84,304 cases in 1953, when national reporting was first began, to 22,201 in 1985.   This represented fairly steady decline of about 5.8% per year. However, the turn down in tuberculosis cases stopped in between 1985 and 1992. In 1992 the annual number of cases increased by 20% to 26,673 cases. (12) The increases were concentrated geographically in several states, with over 90% of the 14,871 cases in California, Florida, New Jersey, New York, and Texas and demographically tuberculosi s occurred in racial and ethnic minorities, in people aged 25 to 44, males and in those born abroad. Especially troubling, and indicative of increasing transmission of new infections, was a 36% increase in tuberculosis among children 4 years old or younger. Tuberculosis appears to be on the decline again in the United States as numbers with only 14,871 cases in 2003. (12) Reported tuberculosis cases in United States, 1982-2002 (12) The percentage of Tuberculosis patients who were born abroad individuals was 42%. People born in Mexico, the Philippines, and Vietnam account for one half of born abroad Tuberculosis patients in the United States. The Tuberculosis rate among born abroad people was 4 to 6 times higher than for US-born peoples. Minimum estimates of the proportion of TB patients with coincident HIV infection were approximately 10-15%. Among people aged 25-44 years, this proportion increased to 20-30%. (12) The fundamental origin of this new Tuberculosis epidemic in troubled states reflects a minimum of four major factors including (1) the involvement of Tuberculosis with the HIV epidemic, (2) the increased migration from countries where Tuberculosis is common, (3) the spread of Tuberculosis in congested settings (health-care facilities, prisons, homeless shelters), and (4) the worsening of the basic health-care infrastructure. (2) Molecular typing of Mycobacterium tuberculosis isolates in the United States in a restriction fragment-length polymorphism study suggests more than one third of new patient incidence results from people-to-people transmission, and the remainder result from reactivation of latent infection. Approximately 1 of 13 Mycobacterium tuberculosis isolates currently shows a form of drug resistance. (2) The modern introduction of biological agents that block tumor necrosis factor-alpha in the treatment of rheumatoid arthritis, psoriasis, and several other autoimmune disorders has additional raised about the necessity of t he identification of patients with latent Tuberculosis. At present, several hundred cases of Tuberculosis have been reported in patients who receive these tumor necrosis factor-alpha antagonists. (2) HISTORY: Tuberculosis has an ancestry which can be traced to the earliest history of mankind. It was recognized as a contagious disease by the time of Hippocrates and Aristotle in 350 BC. Signs of skeletal Tuberculosis were identified in Europe since Neolithic times and in ancient Egypt around 3700 BC in mummified bodies. Evidence of TB appears in Biblical scripture, in Chinese literature dating back to around 4000 BC, and in religious books in India around 2000 BC. (5) During1600s and 1800s tuberculosis was known ass the Great White Plague in Europe.   Other names for Tuberculosis were Phthisis which was from Greek term phthinein, meaning to waste away, scrofula which were used for swellings of the lymph nodes of the neck and consumption which were used as progressive wastin g away of the body.(2) In 1826 Laennec first reported cutaneous tuberculosis which he called PROSECTOR WART. Following Laennec, Rokitansky and Virchow described the histological features in detail comparing them to those of visceral tuberculosis. (6) The Incidence of TB increased with population density and urban development so that by the Industrial Revolution in Europe in 1750, it was responsible for more than 25% of adult deaths. Indeed, in the early 20th century, TB was the leading cause of death in the United States. In 1882, a German biologist ROBERT KOCH presented his discovery of the organism that caused TB. NEIL FINSEN won the Nobel Prize in Medicine in 1903 for introducing UV light into the treatment of skin TB. (2) With the help of better living conditions and the introduction of the antibiotic streptomycin on 20th November 1944, the number of reported TB patients in the United States steadily declined around 126,000 TB patients in 1944, 84,000 in 1953, 22,000 in 1984, and 14,000 in 2004.(2) MODE OF TRANSMISSION: Tuberculosis is an airborne contagious disease that occurs after inhalation of infectious droplets expelled from patients with laryngeal or pulmonary Tuberculosis during coughing, sneezing, or speaking. Each cough can generate more than 3000 infectious droplets. Droplets are so small around 1 to 5 micro meter, that they remain airborne for hours. (2) The likelihood that disease transmission will occur depends upon the infectiousness of the tuberculous patient, the environment in which exposure takes place, and the duration of exposure. Roughly 20% of people in the infected household contact develop infection. Micro epidemics have occurred in closed environments such as transcontinental flights and submarines. Tuberculin sensitivity develops 2 to 10 weeks after infection and usually is lifetime. (2) Because Tuberculosis induces a powerful immune response, individuals with positive tuberculin reactions are at a considerab ly lower risk of acquiring new tuberculous infection. In HIV-infected individuals, active Tuberculosis is more likely to occur from reactivation of existing disease than from superinfection with a new mycobacterial strain. (2) Without treatment, an estimated 10% lifetimes possibility exists of developing active disease after tuberculous infection, 5% occurs within the first 2 years and 5% thereafter. An Increased risk of acquiring active disease occurs during HIV infection, Intravenous drug abuse, diabetes mellitus, silicosis, immunosuppressive therapy, cancer of the head and neck, hematological malignancies, end-stage renal disease, intestinal bypass surgery or gastrectomy, chronic malabsorption syndromes and low body weight. Infants younger than two years are associated with increased risk. (2) 1) DIRECT INHALATION: The most common mode of entry via portal in to the lungs usually resulting from the Inhalation of airborne droplets containing a few bacilli, expectorated by individuals with â€Å"open† pulmonary disease.(8) 2) INDIRECT INHALATION: A) Ingestion: Less often bacilli may be swallowed and lodge in to the tonsil or in the wall of the intestine. These infections are chiefly related to the consumption of contaminated milk products. (8) 3) INOCULATION: Cutaneous tuberculosis manifestations depend upon the method of cutaneous inoculations, which may be exogenous that is from an out side source, may occur by autoinoculation, or may be by endogenous .Direct exogenous inoculation in an individual not previously infected with tuberculosis causes primary tuberculosis infection, will led to the tuberculous ‘chancre or to tuberculosis Verrucosa cutis depending upon the immune status of the patient. Another example of exogenous transmission is lupus vulgaris at the site of BCG vaccination. (9) Endogenous transmission can occur by continuous extension of tuberculous process underlying the skin as in scrofuloderma, by the wa y of lymphatic as in lupus vulgaris and by hematogenous spread as in acute miliary tuberculosis or lupus vulgaris. (9) Infrequent mode of transmission is direct implantation in to the skin through cuts and abrasions. These troubles usually in persons, working with infected material or cultures of tubercle bacilli. These skin lesions were called as â€Å"Prosector warts† (8) CLASSIFFICATION OF CUTANEOUS TUBERCUCLOSIS: Cutaneous tuberculosis clinical manifestations comprise a considerable number of skin changes, usually sub classified in to more or less distinct disease forms. Classification depends on morphology more recently mode of transmission or the immunological state of host, but none of them satisfies completely. 1)INOCCULATION TUBERCUCLOSIS (Exogenous Source) Tuberculosis chancre Warty tuberculosis(Verruca cutis) Lupus vulgaris(some) 2) SECONDARY TUBERCULOSIS (Endogenous source) A) Contiguous spread Scrofuloderma B) Auto-inoculation Orifical tuberculosis 3)HAEMATOGENOUS TUBERCULOSIS Acute miliary tuberculosis Lupus vulgaris(some) Tuberculous gumma 4)ERUPTIVE TUBERCUCLOSIS (Tuberculids) A) Micropapular Lichen scrofulosorum B) Papular Papular/Papulonecrrotic TB C) Nodular Erythema induratum(Bazin) Nodular Tuberculids (CLASSIFICATION OF TUBERCULOSIS, MODIFIED FROM beyt et al) (4) CHAPTER-2 CLASSIFICATION OF MYCOBACTERIA: Tuberculosis is an infectious disease which is caused by the Mycobacterium species. Mycobacteria are acid fast, non-sporulating, non-motile weakly gram positive organisms. TEM micrograph of Mycobacterium tuberculosis Table 3: Kingdom Bacteria Phylum Actinobacteria Order Actinomycetales Suborder Corynebacterineae Family Mycobacteriaceae Genus Mycobacterium Scientific classification by Lehmann Neumann. (3) In 1950s Runyon classified the atypical mycobacteria according to their ability to form pigment, their rate of growth colony characteristics. This classification also includes obligate human pathogens and facultative human pathogens. (1) Today more then 60 species of mycobacteria are identified. Around 41 of these were included in the approved lists of bacterial names in 1980. (9) 30 species of mycobacterium are known that can cause disease in humans. The most common causative organism includes: Mycobacterium tuberculosis Mycobacterium Leprae. Atypical mycobacteria. The species which produce disease in tuberculosis primary complex include: Mycobacterium tuberculosis. Mycobacterium Bovis. Mycobacterium Africanum. Sometimes Bacillus Calmette Guerin (BCG) may also cause disease. (1) MEDICAL CLASSIFICATION: For the purpose of diagnosis treatment mycobacteria can be classified in several major groups. Mycobacterium tuberculosis complex, which can cause tuberculosis by the pathogens Mycobacterium tuberculosis, M Bovis, M Africanum M microti. Mycobacterium Leprae, which causes Hansens disease. Nontuberculous mycobacteria are the mycobacteria which can cause pulmonary disease, lymphadenitis, and skin disease disseminated disease. SLOW GROWING MYCOBACTERIA RUNYON GROUP 1)Obligate human pathogens M. tuberculosis-bovis group including bacillus Calmette-Guerin(BCG) M Africanum (not included in runyon classification 2)Facultative Human pathogens M. kansasii I M. marinum I M. simiae I M. scrofulaceum II M. szulgai II M. gordanae II M. avium-intracellualr complex III M. haemophilum III M. Ulcerans III M. xenopi III 3) Nonpathogens M. flavescen II M. terrae complex III M. trivale III M. gastri III RAPIDLY GROWING MYCOBACTERIA 1))Facultative Human pathogens M. fortuitum I V M. chelonae I V M. abscessus I V 2) Nonpathogens M. smegmatis I V M. phlei I V M. vaccae I V others STAINING CHARACTERISTICS OF MYCOBACTERIA: Mycobacteria are aerobic, facultative, intracellular non-spore forming and non-motile curved rods measuring 0.2- 0.5 by 2-4 um. Mycolic acid rich long chain glycol lipids and phospholipoglycans, a mycocides present in the cell wall of mycobacteria protect them. (2) Mycobacteria do not gram stain readily but their most valuable staining characteristic is Acid Fastness. This ability retains carbol fuchin dye after washing with acid or alcohol occurs because of the high content of cell wall mycolic acids, fatty acids other lipids. Other staining methods used include Dietrele, auramine-Rhodamine and phenolic acridine orange stains. Nocardia rhodococcus, legionella dadei, isospora cryptosporidium also share acid fastness. (1) The Ziehl-Neelson acid-fast stain, while highly specific for mycobacteria, is relatively insensitive, and recognition requires at least 10,000 bacilli per mL; most clinical laboratories currently use a more sen sitive auramine-rhodamine fluorescent stain (auramine O). Routine culture uses a nonselective egg medium called Lowenstein-Jensen or Middlebrook 7H10 and often requires more than 3-4 weeks to grow because of the 22-hour doubling time of mycobacterium tuberculosis. Radiometric broth culture, BACTEC radiometric system of clinical specimens significantly reduces time 10 to 14 d for mycobacterial recovery. DNA probes specific for mycobacterial ribosomal RNA categorize species of clinically significant isolates after recovery. In tissue, polymerase chain reaction (PCR) amplification techniques can be used to detect Mycobactereria tuberculosis-specific DNA sequences and thus, small numbers of mycobacteria in clinical specimens. (2) The cell wall of mycobacteria consist of: (3) Outer lipids Mycolic acid Polysaccharides(arabinoglactan) Peptideglycan Plasma membrane. Lipoarrabinomannan(LAM) Phosphatidylinositol mannoside. Cell wall skeleton. PATHOGENESIS: The most common site for Tuberculosis disease is lungs and 85% of TB patients present with pulmonary symptoms. The most common sites of extrapulmonary disease are mediastinal, retroperitoneal, and cervical lymph nodes, vertebral bodes, adrenals, meninges, and the GI tract. Pathology of these lesions is similar to those in the lung. Extrapulmonary TB can occur as part of a primary or late generalized infection or as a reactivation site that may, coexist with pulmonary reactivation. (2) Mycobacterium tuberculosis is an obligate pathogen. It is a slender aerobic rod, characterized by high lipid content. This lipid is responsible for resistance to phagocytosis. Identification of organism is easy in tuberculous chancre, scrofuloderma, orificial lesions and the miliary variant. This may be difficult to find or absent in lupus vulgaris, gummata and warty tuberculosis. The organism is highly resistant to drying to drying and therefore can retain infectivity by inocula tion or contamination of minor wounds. (19) The reaction of the bacterium depends on: the size of inoculum. the virulence of organism. The immune state of patient. After mycobacteria have invaded the host, either they may multiply and caused progressive infection or their multiplication is checked or completely arrested. The balance between bacterial multiplication and damage is depend not only properties of the invading organism but also by the ability of the host to control such infection. (9) Once the bacteria have invaded, the interaction of T-lymphocyte and mycobacteria antigens, displayed on the surface of antigen presenting cells, induces the liberation of lymphokines, interlukins and intereferons. These substances encourage the activation and expression of MHC molecule II antigens and IL-2R on T-Lymphocytes. Macrophages gather and a granuloma is formed. During the initial sensitization T cells generated and these will remain for decades in affected organ and the circulation. (6) In HIV infection, cell mediated immunity is impaired and therefore there may be reactivation of disease. (6) With the onset of host-immune response, lesions that develop around mycobacterial foci can be either proliferative or exudative. Both types of lesions develop in the same host, since infective dose and local immunity differ from site to site. (2) Proliferative lesions develop where the bacillary load is small and host cellular-immune responses dominate. These tubercles are condensed with activated macrophages admixed and are bounded by proliferating lymphocytes, plasma cells, and an outer rim of fibrosis. Intracellular killing of mycobacteria is effective, and the bacillary load remains low. (2) Exudative lesions predominate when large numbers of bacilli are present and host defenses are weak. These loose aggregates of immature macrophages, neutrophils, fibrin, and caseation necrosis are sites of mycobacterial growth. Without treatment, these lesions progress and infection spreads. (2) Even though mycobacteria are spread by blood all over the body during initial infection, primary extrapulmonary disease is rare e xcept in severely immunocompromised hosts. Resistant hosts control mycobacterial growth at distant foci before expansion of active disease. Infants, older persons, or otherwise immunosuppressed hosts are incapable to control mycobacterial growth and develop disseminated Tuberculosis. Patients who become immunocompromised months to years after primary infection also can develop late generalized disease. (2) HISTOLOGY: The tubercle is the feature of the tuberculosis and infections with some of the atypical mycobacteria. In early stages of the skin lesion there is non specific inflammation but tubercle formation occur with in a month. (20) A tubercle granuloma consists of foci of epitheloid cells, containing variable, but usually sparse number of langerhans giant cells, with surrounding by a rim of mononuclear cells. The centre of this tuberculoid granuloma may shown a caseation necrosis which may calcify. (20) Even though tuberculoid granuloma is highly characteristic for several forms tuberculosis, but it is not pathognomic. Syphilis, leprosy, deep fungal infection and some other disease can also produce similar type of lesions. However differentiation of tuberculosis from these conditions sometimes may not be easy. (20) MICROSCOPIC ASPECTS: The involvement of an organ by tuberculosis is related with an inflammatory reaction at the affected site. There are three consecutive stages of inflammation, which are acute, subacute and chronic. These stages have different histological aspects. (21) 1) THE ACUTE PHASE: Infection first leads to a rapid, nonspecific inflammatory reaction apparent by exudative lesions, which are not predominantly specific to tuberculosis. The focus of inflammation is the site of serous-fibrous exudates with abundant macrophages in the centre. (21) 2) THE SUBACUTE PHASE: Lysis of the bacilli liberates the phospholipids from their capsule, provoking a specific tissue reaction and the formation of follicles  "Koester follicles†. Two kinds of follicular lesions may be observed. (21) A) The epitheloid giant cell follicle: These are rounded focus containing numerous epitheloid cells, which are monocyte with egg-shaped centre, abundant cytoplasm and indistinct cytoplasmic edges. Several Langhans giant cells, generally situated din the centre of the follicle. These are large cells with abundant cytoplasm, indistinct edges and multiple centres arranged in the shape of a crown or horseshoe. Langhans cells are formed by the fusion of epitheloid cells. Epitheloid cells and langhans cells created by the monocyte, under the action of lymphokines. There is also a peripheral crown of lymphocytes. (21) This follicle does not contain necrosis and is not specific for tuberculosis. It is common to tuberculous leprosy, sarcoidosis and connective tissue diseases. (21) B) The necrotizing granuloma: The epitheloid giant cell follicle presents with central Caseating necrosis. This lesion is very specific for tuberculosis. Caseating necrosis is a fine-grained, homogeneous eosinophilic necrosis. (21) 3) THE CHRONIC PHASE: The tuberculous follicle gradually develops in to a fibrous follicle. Collagenous fibres invade the tuberculous focus, which is enclosed in a fibrous shell with fibroblast and lymphocytes; forming a fibro-Caseating follicle that is then transformed into a fully fibrous follicle this follicle can become entirely calcified. (21) The key examination for confirming the diagnosis of tuberculosis is bacteriology. Histology does play an important role in confirming diagnosis of extra pulmonary tuberculosis. Combination of both histological techniques and bacteriology increase the yield of histology. (21) MICROBIOLOGY: Tubercle bacilli are aerobic, with lipid-rich walls and a slow rate of growth. They take 20 hours on average to double in number. The lungs, dark and oxygen rich, at a temperature of 37 °C, provide an ideal environment for th e bacilli to replicate .Tubercle bacilli are rapidly destroyed in the ambient environment by ultraviolet rays. It is difficult to stain the bacilli with stains commonly used for other bacteriological examinations. They require special stains that can penetrate the wax-rich wall of the bacillus. For bacteriological examination, the quality of the samples sent to the laboratory is of fundamental importance. For pulmonary tuberculosis: The specimen that should be collected for examination is sputum obtained from the patient after coughing; more rarely the sample is obtained by gastric aspiration or bronchoscopy. As sputum can be contaminated by other bacteria, it must be collected in clean sputum non-sterile containers that can be firmly sealed. For extrapulmonary tuberculosis: Fluid from serous effusion, cerebrospinal fluid or biopsied fragments can be sent to the laboratory for culture. All sampling must be performed in strictly sterile conditions so that culture can b e performed directly without prior decontamination. Samples must never be placed in formol, which kills the bacilli. bacteriological techniques Microscopy A smear of a selected part of a submitted specimen is made on a slide, then examined by microscope after staining †¢ Staining methods There are several staining methods used for the tubercle bacillus; it is important for the method or methods used to be standardized for each country. The stains that are the most effective are Ziehl-Neelsen (ZN) staining and auramine staining. Ziehl-Neelsen staining The smear is covered with carbol fuchsin, and then heated. The smear is then destained successively using sulfuric acid and alcohol. All of the smears must be almost totally destained, and then restained with methylene blue. The bacilli are stained red by the fuchsin and are resistant to the acid and alcohol, hence the name acid-fast bacilli (AFB). Destaining by the successive application of acid and a lcohol can also be done using only 25% sulfuric acid; however, it should be applied several times until the smear is completely destained. This is the method recommended by the IUATLD, as it is less delicate and does not require alcohol (which is not always available in some countries). On microscopic examination of the stained smear, the tubercle bacilli look like fine, red, slightly curved rods that are more or less granular, isolated, in pairs or in groups, and stand out clearly against the blue background. Fluorescent auramine staining The fuchsin is replaced by auramine; the bacilli fix the fluorescent stain and retain it after the acid and alcohol staining. †¢ Reading by microscopy After Ziehl-Neelsen staining The stained smear is examined using a binocular microscope with an immersion lens (magnification  ¥100). The number of AFB per 100 fields ,about one length and one width of a slide are counted. This technique is simple, rapid and fairly in expens ive. After auramine staining The stained smear is examined by fluorescence microscopy with a dry lens of low magnification (*25 or 40). This microscope has an ultraviolet lamp to enable the fluorescent bacilli to be seen: they are clearly visible in the form of greenish-yellow fluorescent rods. The sensitivity and specificity of examination by fluorescence microscopy are comparable to those of microscopy after ZN staining. The main advantage is the easy and rapidity of reading: on the same slide surface, the results of 10 minutes reading by optic microscope are obtained in 2 minutes on fluorescence microscopy. As this technique requires more costly equipment (the microscope itself, and the lamps, which need to be replaced frequently ,on average after 200 hours of use, it is cost-effective only if more than 30 slides are examined each day. A constant electricity supply and trained technicians are also indispensable CHAPTER -3 TYPES OF CUTANEOUS TUBERCULOSIS: INTRODU CTION: Scrofuloderma and lupus vulgaris are the two most common forms of tuberculosis. However, the pattern of cutaneous tuberculosis is changing, as the tuberculid, lichen scrofulosorum, is becoming more common over recent years and has occurs almost as frequently as scrofuloderma and lupus vulgaris. 1) SCROFULODERMA: Syn- Tuberculosis colliquativa, scrofulous gumma. DEFINITION: Scrofuloderma is a subacute form of subcutaneous tuberculosis which causes cold abscess formation and secondary breakdown of overlying skin. PATHOGENESIS: Scrofuloderma results from the contiguous involvement of the skin overlying another tubrculous process for example, tuberculous lymphadenitis, tuberculosis of bone and joints, or tuberculous epididymitis. (9) INCIDENCE: Scrofuloderma may affect all groups but historically, a high prevalence of scrofuloderma was seen in children infected with Mycobacterium bovis from contaminated nonpasteurized milk (which type cow ). CLINICAL FEATURES: Lesions present as firm, painless, subcutaneous nodules that progressively enlarge and suppurate and then form ulcers and sinus tracts to the overlying skin. Typical ulcers have undermined edges and a floor of granulation tissue. Typical tubercles with acid-fast bacilli are found in the lower dermis and the walls of the ulcer or abscess. Tubercle bacilli usually can be isolated from the purulent discharge. Tuberculin sensitivity is usually marked. Natural healing can occur but often takes years and may be accompanied by the formation of hypertrophic scars. Lupus vulgaris may develop in the locality of healing scrofuloderma. (2) Cervical lymph nodes are infected most commonly on the same side of the neck as the primary tuberculous complex. In the neck submandibular, preauricular, tonsillar, postauricular, occipital and supraclavicular lymph nodes are usually implicated. Occasionally discharging sinuses may occur over areas devoid of lymph nodes. Over weeks to mont hs the involved lymph nodes enlarge, turn livid red, suppurate and then perforate with resultant ulceration and fistula formation. (11) Progression of disease with scarring produces irregular adherent masses, densely fibrous in places and fluctuant or discharging in others. Fungating tumors may arise from the excessive granulation tissue and after healing characteristic puckered scaring at the site of the infection. (4) COURSE: Spontaneous healing does occur (what % ? ) but it takes years before it is a completed. The typical cribriform or criss-crossed scarring and localized recurrence are common. 2) LUPUS VULGARIS: Syn: Tuberculosis cutis Luposa DEFINITION: In most reporting publication, Lupus Vulgaris is the most common form of Cutaneous TB and has the most unpredictable presentation. Lupus vulgaris is a chronic and progressive form of Cutaneous TB that occurs in tuberculin-sensitive patients. Hypersensitivity to tuberculin is high although immunity is low to moderate. (11) The mode of infection is not entirely clear in the individual case but it is considered that Lesions appear in normal skin either as a result of direct extension of underlying tuberculous foci, in lymphatic or hematogenous spread, after primary inoculation, after BCG vaccination, or in the scars of old scrofuloderma. INCIDENCE: Traditionally, lupus vulgaris was most common in northern Europe and less common in Asian countries ( figures), with affected females outnumbering males by 2-3:1. All age group affected equally. (2) CLINICAL FEATURES: Lesions are small, sharply marginated; red-brown papules of gelatinous consistency called apple-jelly nodules. This apple-jelly nodule slowly evolves by peripheral extension in to large plaques with central atrophy. Lesions are frequently solitary, and more than 90% involve the head and neck. Re-emergence of new active tuberculosis nodules within earlier atrophic or scarred lesions is characteristic. If the Cart ilage of the nose and ears is involved, it is gradually destroyed. This destruction of tissue is known as lupus vorax. Bone usually is spared. Buccal, nasal, and conjunctival mucosa may be involved primarily or by extension. (2) Lupus Vulgaris is more common in western countries on the face, especially on cheeks, nose, ears, and on the extensor surface of the extremities, also on the breast buttocks. In many developing countries including India the lower extremities mainly the buttocks are the primary site of involvement. Mucous membrane involvement is very rare in Lupus Vulgaris. (11) VARIANTS OF LUPUS VULGARIS: There are many clinical types depending upon the local tissue response to infection. 1- PLAQUE FORM OR LUPUS VULGARIS EXFOLIATIVE: This form of lupus vulgaris is characterized by the plaques. Scaling frequently occurs on the lower legs where it may resemble psoriasis. As the lesion enlarges they become softer. Over a period of time a polycystic or serpiginou s configuration can develop with central clearing and atrophy in the lesion. Irregular scarring is frequent and the active edge may be thickened and hyperkeratotic. (2) 2) ULCERATING AND MUTILATING LUPUS VULGARIS: Scarring and ulceration be the main clinical features. Crusts form over areas of necrosis. Deep tissues and cartilage are invaded and ultimate scarring of the disease produces contractures and distortion. (2) 3) LUPUS VULGARIS VEGETANS OR LUPUS PAPILLOMATOSUS: This form of lupus vulgaris is characterized by necrosis, ulceration, and proliferative and papillomatous granulation tissue. It involves mucous membranes sometimes, and invades and destroys the cartilage when involving nasal and auricular cartilage. (2) 4) NODULAR FORM OF LUPUS VULGARIS: In this form of lupus vulgaris large soft tumors appears usually on ear lobes. These are characterized by an absence of ulceration and scarring. (2) 5) LUPUS POSTEXANTHEMATICUS: It is disseminated, papular an d nodular form that commonly arises after a transient impairment of immunity predominantly after measles.(9) ( complete lesion picture) 6) LUPUS VULGARIS OF MUCOUS MEMBRANE: Mucous membrane tuberculous lesions are extremely rare. These lesions are small soft, gray or pink papules, ulcers or granulating masses that bleed easily. They arise in mucous membrane by direct extension of skin lupus to buccal, nasal or conjunctival mucosa. This form can produce severe destruction can produce stenosis of the larynx and scarring deformities. (9) DIAGNOSIS OF LUPUS VULGARIS: Lupus vulgaris is difficult to diagnose when it occur in unusual sites like popliteal fossa. Special stains and mycobacterial cultures may be having frequently negative in these sites. However, it is possible to reach the correct diagnosis of Lupus vulgaris by using clinical and histopathological findings. In such cases, to confirm the diagnosis at times, a therapeutic trial with antitubercular agents may be re quired. (17) COURSE: Lupus vulgaris is a very destructive disease and without treatment can progress slowly over years or even decades. It can cause severe scarring and disfigurements like Ectropion, and others distortion of the mouth and severe damage to the nose may occur. (11) CUTANEOS TUBERCULOSIS IN CHILDREN: Cutaneous tuberculosis in children is a most important health problem in India. It accounts for about 1.5% of all the cases of extra pulmonary tuberculosis Overall the clinical patterns are comparable with adults. However, children can have widespread and severe involvement because many unusual and infrequent patterns are known to occur in children. Underlying systemic involvement(what invovlment) is more common in children with lupus vulgaris, compared to adults with lupus vulgaris. (13) Cutaneous tuberculosis is extensive in Pakistan but has not been adequately documented. One study was conducted to establish the clinical patterns, incidence and prevalence of the disease in Larkana, Sindh province, Pakistan. This study showed the number of patients was reasonably has large, thus suggesting a high incidence of cutaneous tuberculosis in Larkana. Lupus vulgaris, a form of cutaneous tuberculosis, was extensive in this area and prevalent in adults, while scrofuloderma was prevalent in children. Additionally, the obtainable rate of the disease was higher in children aged under ten years of age and lower in adults. This showed that children are more prone to this disease than adults in Larkana.(complete ratio of patients) (14) Ocular scrofuloderma with orbital tuberculosis is a rarely described presentation of childhood tuberculosis. Bilateral eye involvement had never been reported. One case report from India,in which a three year old boy who presented with bilateral infraorbital swellings of tubercular etiology. Computed tomography (CT) scan of the upper face revealed enhanced soft tissue lesions in both the lower lids of the eyes, wit h extraconal extension into the orbits and with erosion of the right zygomatic bone. The cause was confirmed by using the Ziehl Neelsen staining of the aspirate from the lesions, which was positive for acid-fast bacilli and growth of Mycobacterium tuberculosis in the aspirate culture. The patient showed marked improvement of his lesions on anti-tubercular treatment. (15) Localized tuberculid has been reported occasionally in the data. The majority of these case reports are of papulonecrotic tuberculid localized to the penis, an entity selected as penis tuberculid. In females, such a localized genital tuberculid has not been reported frequently. There is one case report from India, in which an 11-year-old girl with lichen scrofulosorum confined to the vulva, associated with cervical and inguinal tubercular lymphandenitis is reported. (16) UNUSUAL MANIFESTATION OF TUBERCUCLOSIS: Long standing lupus vulgaris can be complicated by Squamous cell carcinoma. Latency period may be 10- 20 years. I am presenting a case report from Romania in which 59 years old farmer lady had lupus vulgaris on right ear lobule, since childhood. which started after her empiric perforation for earrings. The development was progressive, strange, involving the pinna and the right cheek in the meantime. At the time of first examination, a diffuse mass of red-yellowish infiltration was found at the level of the right ear and the right cheek. In the following two years, an ulcer-vegetating tumor developed at the level of the right ear lobule, along with retromandibular adenopathy, of about 1 cm, histopathological examination confirmed the diagnosis of squamous cell carcinoma developed from a lupus vulgaris. (18)

Frankenstein Essay - 1176 Words

Many people know that Mary Shelley, the author of Frankenstein, was part of a family of famed Romantic era writers. Her mother, Mary Wollstonecraft, was one of the first leaders of the feminist movement, her father, William Godwin, was a famous social philosopher, and her husband, Percy Shelley, was one of the leading Romantic poets of the time (Frankenstein: Mary Shelley Biography.). What most people do not know, however, is that Mary Shelley dealt with issues of abandonment her whole life and fear of giving birth (Duncan, Greg. Frankenstein: The Historical Context.). When she wrote Frankenstein, she revealed her hidden fears and desires through the story of Victor Frankenstein’s creation, putting him symbolically in her place†¦show more content†¦In a fit of passion he destroyed the unfinished female creature, so that it could not kill him. This is the manifestation of Shelley’s repressed desire to never give birth to another child. The first creature, i n anger at the loss of a future mate, took revenge on Victor. The creature led his creator across the globe and through terrain in which Victor could not survive. This chase lasted several months, ending in the Arctic Circle, and caused the death of his creator. Another recurring theme is that of the child abandoned by the parents. Elizabeth, before being adopted into Victor’s family, was abandoned by her birth parents- her mother had died, and her father was in jail. Victor’s closest friend, Henry Clerval, was mainly neglected by his father. Henry’s father was â€Å"a narrow-minded trader and saw idleness and ruin in the aspirations and ambition of his son† (54). He denied Henry an education, though Henry wished more than anything to accompany Victor at the university. Lastly, Victor left his creature shortly after giving him life. The creature can be said to be a representation of Shelley’s id, a manifestation of all her suppressed feelings (Hicks, Elizabeth. 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Food Habits Changing After Food, Inc Free Essays

The documentary Food, Inc was created to show viewers what is being put on their plates and has given me an altered view towards the food industry which has drastically changed my food habits. Many emotional scenes were shown on this film to give viewers empathy towards the problem that is occurring. The documentary shows many vivid details and explains what is in the food that consumers eat. We will write a custom essay sample on Food Habits Changing After Food, Inc or any similar topic only for you Order Now The film food, Inc influenced my habits of consumption by eating organic meats, purchasing most foods in the farmers market, and checking for food labels. I have learned that there is a big difference in organic and non-organic meats. Animals raised organically are not allowed to be fed antibiotics or other drugs and cannot eat genetically modified foods. Eating organic meats is not only helping animals but also preventing the consumer from a possible disease outbreak that may occur due to the mistreatment of animals. The meat comes from a sustainable farm that uses the manure productively as organic fertilizer. The manure is â€Å"pure,† coming from animals fed an organic diet which ensures consumers that there will not be any exposure to chemicals. Consumers feel safe knowing that the certified organic meat won’t hurt them in the long-run. Going to a farmers’ market helps consumers because everything is fresh, locally grown, and certified organic which gives the buyer no doubts. When purchasing meat from an organic farm stand at a farmer’s market, consumers support that farm. On the other hand, buying non-organic meat that isn’t local, free-range, or ranch-raised from a supermarket chain will most likely support a multinational food corporation. After the experience change in some of the famers’ supermarkets, I also started realizing the foods tasted better and after eating, I felt lighter and full at the same time. I also saw that costs were higher than the farmers’ markets but it truly made a difference to purchase organic produce and meats. It decreased health risks like diabetes and obesity. Food labels are essential to consumers because they stay alert with what they eat everywhere they go. I have always wondered how many calories are in the food in restaurants as well as other types of foods that I buy at the grocery store. Most restaurants don’t list the actual nutritional value of their food which is why it’s important for consumers’ to remember to check and be aware of what is going to be in their bodies. The film transmits this message to its viewers by showing consumers foods that have glucose and Trans fat than expected. There can be many ingredients or a high number of calories that a consumer may not know about but after looking at a label, it will give the consumer peace of mind or change their mind on whether they will eat it or not. Food, Inc helped me realize and understand that it’s critical for consumers to be cautious about how different foods can affect their overall health. This led me to change some of my eating habits such as buying organic meats, which helped me choose my foods wisely. Being aware lets consumers like me stay healthy. Food, Inc taught me a lot about buying organic animal products because it’s better for health, the community, and it can also benefit consumers in the long-run. I would recommend that all consumers watch this film and understand the positive aspects of it because it gives some critical points about the food industry and backs them up with evidence. Food is important for the body and it helps an individual survive every day, but it can also be deadly. It’s all about making the right decisions when it comes to the consumers’ food habits. How to cite Food Habits Changing After Food, Inc, Essays

Witch Of Wall Street - Hetty Green Essays - Economy,

Witch Of Wall Street - Hetty Green The Witch of Wall Street A musical based on the life of America's first great female financier, Hetty Green After watching the play, The Witch of Wall Street, and giving it a lot of thought I have analyzed the questions we were given and decided that just answering one wouldn't do the play or the storyline any justice. Therefore I have decided to run through the play in segments answering all five questions in the process of doing so. 1- Describe the plot of the play. 2- Describe the obstacles and opportunities Hetty Green had in the result of her success. 3- What were the main benefactors and antagonizers. The lifetime accomplishments of Hetty Green all started at a young and tender age when she would hang around the docks her father owned, where she was instilled with a certain attitude towards business. She was quite a tomboy, understanding the lingo of the whalers and learning the business. She was her fathers pride and joy, quick to numbers, always giving him the answers he wanted. Her mother, who was an ill and frail woman, was unhappy that she wasn't like other girls her age. While her father blamed her mother for not even being able to produce a son, Hetty, mature and sensitive for her age continued to only do one thing; be the best in her father's eyes. Competitiveness, the need to be successful and the desire to be only the best reigned her persona. Hetty's mother warned her daughter that her father was a shrewd and selfish man. She made sure to tell Hetty that when she died, the entire business would belong to her, despite her father's words? She warned her daughter not to trust anyone, while Hetty would cry to her, promising to make her happy, be rich and successful and buy her mother a beautiful big house. After her mother died, Hetty was introduced to the cold brutality of the world and it was the first notch of trust she lost in her father. Right after the funeral the lawyer announced that all assets would belong to Robinson. Hetty protested to her father questioning what would happen to his promise of Robinson and Daughter? To which her father, aptly - as was his ability to do, turned the entire scenario around, first slapping her and throwing a huge guilt trip on her, which made her apologize for not trusting him? Robinson and Daughter would do just fine in his hands? As Hetty grew older, watching the docks, little did sh e realize that her father was scheming and running the business according to his desire without consulting her. One day as she was watching the big ships with her father, she noticed something odd and questioned where they were going? After her father tried to dodge the question for a little bit by marveling at how pretty and tall she has become, he answered sheepishly that they were going to be sunk and sold for the war efforts. This was an investment for himself (as he thought) for after the war. Hetty is struck by a forceful thought; she can never trust anyone. This part of her growing up had a major effect on the way she conducted her business. Hetty grew up with a protective shell, juggling the balls in a way to keep both her parents happy, having to keep up with her father's ridiculous expectations. He himself wasn't able to keep his word; she lost trust in him at a young age. When Hetty grew older and attended a school for fine young girls she was quick to realize that she was an outcast, she had no social skills, she had no interest in the petty things other girls her age wanted and was on an extremely different wavelength than the rest of them. This formed her to a greater extent. She was a tough nut to crack and for one reason ? she learned that the best defense against the world was beating them at their own game. Hetty was still unmarried at the age of twenty-five. Once again, her father, the cunning shrewd man that he was, got her to play his game, and set her

Kim essays

Kim essays The book, Kim, was written by Rudyard Kipling. It is a story about a poor, Irish boy named Kimball OHara, shortened to Kim, who travels around colonial India seeking adventure. He is an orphan and has lived all his life in this British colony. Kim later meets a lama, a monk of a religion similar to Bhuddism, and searches with him for a holy river that cleanses all sins. One day, he met the people in the regiment his father, who had passed away long before Kim was born, used to work in. He was sent to school to learn and to be transformed into a sahib, another word for a master. After his schooling was over, he learned many skills from people, such as manipulating minds. The cunning boy also knew how to steal, lie, cheat, and to beg for food and housing. With these skills the British Secret Service sent him on a mission to capture the maps, letters, notes and diagrams of Russian spies in the Himalayas. At the end, he accomplishes his mission and the lama, who had been searchin g unsuccessfully in vain, found his river quite on accident. Now that I have read the book, I wish that I could learn more about colonial India and its different cultures. It may sound boring, but Rudyard Kipling writes it in such a way that it becomes extremely interesting and it makes people yearn to learn more about the Indian culture. Some examples of Indian culture are how people are categorized. The upper-class people are called sahibs. Another interesting term is babu. This word means an educated native person speaking English. What is funny about this is that this is a rude way of addressing a person and it was also used to poke fun because of their broken English and strange accent. The British were racist towards the natives. Not only is this what makes the book interesting, but also how the people lived in India. Unlike America where there are many middle-class people, India had mainly two different types of people. They were ...

How to Cheat on the ACT

How to Cheat on the ACT SAT / ACT Prep Online Guides and Tips Disclaimer: we are not going to tell you how to cheat on the ACT. What we will tell you about are things you can get in trouble for, along with high-profile cheating scandals that have happened recently and in past years. We do not advocate cheating by any means! Let's take a look at some of these scandals, as well as make sure you're aware of all the rules and regulations of test day so you don't inadvertently jeopardize your scores or chance of college admissions. South Korea and Hong Kong:The Case of the Leaked Test The most recent cheating scandal around the ACT involves the June , 2016 administration of the test in South Korea and Hong Kong(or what was supposed to be the June administration). Officials heard that test materials had beenleaked in advance of the test. ACT, Inc's official statement was this: "ACT has just received credible evidence that test materials intended for administration in these regions have been compromised." The result? ACT, Inccanceled the test altogether, doing so only hours before students were supposed to take the test. About 5,500 students at 56 different test centers were unable to take the test they had registered for. While these students will get refunds, they don't get the chance to reschedule their June test. Instead, they'll have to wait until the next official ACT test date in September. At this point, it's unclear who got their hands on ACT test materials or how they did it. While the ACT has never been canceled abroad before, the SAT has been canceled or investigated several times over the past few years in both South Korea and Hong Kong. It seems that test centers take advantage of time zone differences to obtain information from students taking tests in the U.S. Unfortunately, it was the test-takers in South Korea and Hong Kong who suffered from this underhanded activity and were unable to take the ACT at all on their scheduled June test date. New York: The Case of False Identities Cheating scandals around the ACT haven't just happened overseas. In fact, thelargest and most high profile scandal to date happened in 20 on Long Island, New York. Over 20 arrests were made in this case where students paid other students (most of them already in college) to take the test in their place. They paid students up to $3,600, and these students used fake IDs to enter the testing center. When these cases of false identity were discovered, the perpetrators were charged with scheming to defraud in the first degree, criminal impersonation in the second degree, and falsifying business records in the first degree. None of these students ultimately faced jail time, but their names and this case will forever be on the public record. Apparently, this kind of identity swapping had been going on for years. As for the aftermath of this scandal? Now all students have to upload a photo of themselves when they register for the ACT. Would you be tempted to pay money if it meant a perfect scorer would take the ACT for you? Kentucky: The Case of Too Many Practice Tests In 2014, the principal and other school officials at Louisville Male High School came under investigation for heavy assistance of students taking the ACT. Because the ACT is used in many states as a high school standardized exam, it's a high stakes test for schools and administrators, as well as students. Several students reported that school officials gave substantial help during their test. Administrators let students take multiple practice tests with the real questions, before entering their real answers for the real test. Furthermore, officials helped students with questions they struggled with and even gave them answers, giving Louisville students an unfair advantage on the actual ACT. Even worse, students reported administrators telling them to keep hush about the cheating in interviews.In the end, the principal was fired from the school, and the school was required to institute new behaviors to prevent this cheating from happening in the future. Michigan: The Case of Calculator Misconduct Similar suspicions swirled around Fremont High School in Michigan in 2014. College Board received an anonymous tip about improper calculator use that indicated that school officials had uploaded far too much information on students' calculators, almost like having a "cheat sheet" while taking the ACT. Ultimately the ACT decided that while their actions gave students an unfair advantage, they had found a loophole in the rules and were not technically cheating. Students scores were eventually released, but they were withheld for a long time while the investigation was underway. While these cases of cheating on the ACT made the news, most cases are less high profile. Instead, they occur because a student or test proctor reports unusual behavior on test day. Let's take a look at the more common causes of ACT scores being withheld or canceled. Don't do this. What Else You Can Be Disqualified From the ACT For The basic signs of cheating - likelooking at someone else's test paper, talking, using inappropriate materials, or causing any disturbances - are all prohibited while taking the ACT. Since it is strictly timed, students cannot look back or ahead in the test booklet. They cannot flip through it or work on a different section than the one currently being timed, nor can they continue to write or fill in answers after time has been called. Once time has been called, that's it - absolutely no more filling in the bubble sheet or adding one last sentence to your essay. Otherwise your test proctor could take your test booklet and ask you to leave the testing center. Once your test has been scored, there may be a few unusual trends that alert scorers to possible signs of cheating. For example, huge fluctuations in your scores could prompt an investigation - if you improve by a great number of points between your first and second test administration, for example, or show large inconsistencies between similar sections. They may ask you to provide a testimonial on your behalf, but could withhold your scores indefinitely or have you retake the test. Another cause for concern is if your answers resemble that of a nearby student too closely. One Boston student was shocked to have her scores withheld, because her answers looked almost identical to a student she sat near. While very rare, these kinds of investigations begin after the tests have been scored and analyzed. So if your scores are withheld, what are the consequences? Consequences of Cheating on the ACT In the high profile New York case, which involved fake IDs and exchanges of large sums of money, actual charges were filed against students and arrests were made. In less nefarious circumstances, like the ones described above, usually the ACT will cancel your scores and you will have to retake the test. If your score reports have already been sent off to colleges, theACT will notify the colleges that your scores are now invalid. They usually won't provide a specific reason, but instead will say, "The ACT cancels scores for a variety of reasons, including illness of the examinee, mis-timing of the test, disturbances or irregularity at the testing site. It is the ACT policy to treat the ACT's reasoning for canceling a specific score as confidential." Colleges won't necessarily hear that you were accused of cheating, but cancellation of scores is still a big red flag that you don't want to have on your application. The college will likely know if your scores were the only ones to be canceled, thereby ruling out "mis-timing" or "disturbances at the testing site" as a possible explanation. Plus, many months will probably pass by the time you get a final decision from ACT, sign up for and retake the test, and receive and send off your new score reports, causing you to miss important deadlines. If your scores were withheld due to inconsistencies, the ACT may have you retake the test. If you score within three points of your last performance, then you will get to keep those new scores. If not, then your new and improved test scores will be canceled and invalidated. For the most part, students whose scores get withheld and/or cancelled may retake the test, but this can be a huge hassle, both emotionally and in terms of getting everything done in time for your college application deadlines. Relax! The ACT is an important test, but there's no reason to lose your head. What Can You Do Instead of Cheating? Don't cheat on the ACT - prep instead! Nothing is a replacement for preparation and familiarity with the content and format of the tests. Check out our free E-Book for the tips and strategies you need to know to improve your ACT score by 4+ points. To prep most effectively, use high quality materials that will show you all the concepts and question types you will encounter, so you really won't need to know the exact questions beforehand. To avoid raising any suspicions about cheating on the ACT, make sure you're familiar with all the instructions and timing of the test. This is especially crucial if English isn't your first language or you're unsure if you'll absorb the exact instructions once the test has been passed out. By knowing the exact instructions before test day, you can focus your energy and attention on the content, rather than on logistical details. As we mentioned above, the testmakers look at your scores to detect any unusual fluctuations or similarities with a nearby test-taker. To prevent this possibility, make sure you take the test seriously every time you take it. Don't treat any administration as a throw-away, as this could become a problem later on down the line. Instead, try your best every time so your scores are an accurate representation of your skills, abilities, and preparation every time you take the test. Finally, try to keep perspective through the pressures of achievement and competition. Make sure to give yourself breaks and use the coping skills that best work for you to alleviate stress, like meditation, mindfulness, and exercise. Try to see the forest through the trees - in other words, do your best to look at the big picture rather than stressing out about one part of it along the way.By acting with integrity and purpose, you will end up in the college that's the best fit for you. What's Next? Now that you know the behaviors that count as cheating on the ACT, what about the personal belongings that must stay out of the testing center? This article explains everything you need on test day, some little known things that could come in handy, and the things you should just leave home. Are you feeling stressed about the ACT? If you're like any other student, the answer is probably yes. This article suggests some practices for managing your anxiety, clearing your mind, and training your focus for test day. Aimingfor a high ACT score? Read our guide onhow to score a perfect ACT 36, written by our resident perfect scorer. Want to improve your ACT score by 4+ points? Download our free guide to the top 5 strategies you need in your prep to improve your ACT score dramatically. Have friends who also need help with test prep? Share this article! Tweet Rebecca Safier About the Author Rebecca graduated with her Master's in Adolescent Counseling from the Harvard Graduate School of Education. She has years of teaching and college counseling experience and is passionate about helping students achieve their goals and improve their well-being. She graduated magna cum laude from Tufts University and scored in the 99th percentile on the SAT. Get Free Guides to Boost Your SAT/ACT Get FREE EXCLUSIVE insider tips on how to ACE THE SAT/ACT. 100% Privacy. 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Reasoning for Bible Allusions in the Bear Essay Example | Topics and Well Written Essays - 750 words

Reasoning for Bible Allusions in the Bear - Essay Example Also Sam Fathers painted Isaac's face with the deer of the blood after his first kill of a deer, a ritual that symbolizes sacrifices. The bear Old Ben, conversely, is a complex object of symbolism. Many scholars interpreted Old Ben as a symbol of strength and willingness of human nature. Some sees him as a symbol of freedom in wilderness. However, in Biblical allusion, Old Ben was compared to the Tree of Knowledge. Hunters are hunting down devotedly the old bear. Not because it was a threat to the nearby civilization, but because of the hunters' pride in the achievement of the wild bear's declination. The curiosity is intriguing and enticing to accomplish. The same goes with the Tree of Knowledge. The fruit of the three was forbidden to eat. Thus it became a center of curiosity for the first man and woman habituated the garden, its taste, its effect after eating it. The majestic figure of the bear fascinated the minds of the Southern Hunters. The rewarding hunters' pride to take down Old Ben was like a devil that tempted Eve to defy and eat the forbidden fruit. It is then tempting the mind towards viciousness of the southern people to go after the cruel reward awaiting. Canaan is obviously referring to the So... It was also directly describing the South where Faulkner himself explored with his early years as well as Isaac's during his early years, as Hebrew Bible illustrated Land of Canaan as extension southward from Gaza to the Brook of Egypt. The civilization in the second part of the story that Isaac gone to had came from the concept of Canaan. Faulkner used both Biblical places to emphasize the contrast between the wilderness and the civilization. From the Garden of Eden, Isaac fled to Canaan, and eventually learned that people in the civilization can be more uncivilized as creatures in the wilderness were, if not being paralleled. This in regards to the lifestyle he witnessed during in his relatives in the South, like McCaslin Edmonds, and Uncles Buddy and Buck. The practice of incest, the deception in the Buck and Buddy's old ledger of ownership, Cass' prejudices, all of these made Isaac to see that Old Ben is a symbol of untamed human willingness and at a same time of great independence of human spirit. The fascination to kill Old Ben was the curse that brought in people's lives towards their greed and viciousness. Now, in the last part of the story, Boon's madness could be the result of the curse in discovering the curiosity of killing Old Ben. The same goes when Adam and Eve have eaten the forbidden fruit of the Tree of Knowledge, a curse bestowed to them along with the knowledge they suddenly acquired upon eating the fruit. Boon suddenly thinks he owns everything in the wilderness as he defeated the most regarded powerful creature in it. He acquired a thinking of replacing Old Ben's mightiness. Thus the impossible possession he had will make him madder eventually. A repeat to the excerpt of Faulkner's description "Arcadian Biblical vision of a world which

TLMT313 WEEK 3 FORUM Assignment Example | Topics and Well Written Essays - 250 words

TLMT313 WEEK 3 FORUM - Assignment Example The approach promotes substitution of methods and materials with cheaper alternatives, without altering the functionality. Value engineering lowers operational and management costs, improves efficiency of resources, simplify procedures and minimizes paperwork. Value engineering helps to reduce staff costs as well as achieving optimum balance between function, performance, safety, quality and cost (Mukhopadhyaya, 2009). Value engineering and value analysis effort should be led by designers, manufacturing and production engineer, purchasing specialist and executive staff. The designers help in making decisions at an early stage of the product concerning product design, specifications, equipment required and the effect of the product to another department. Production and manufacturing engineers determines how the product is to be made, and they manage the production process. Purchasing specialists help to convert design elements into material specifications. Operational staff makes the product and deliver service. They also provide the necessary information about production problems. Supply management supports the process by converting design requirements of the product to material specifications. They source materials required to develop the product and suggest suppliers of the materials to the

Barriers to Breast Cancer Screening and Mammograms

Barriers to Breast Cancer Screening and Mammograms Abstract The mammography screening recommendations have been ambiguous and disagree with suggesting institute to institute.   Thus, it is up to women to make choices about mammogram inspection based on their personal health beliefs.   This paper explores 6 published articles that report results from various research conducted on women with an average risk of breast cancer. These studies examined the connection between observed benefits and alleged barriers to mammography and compliance with mammography screening in women age 40 and older and among minorities.   It also discusses the latest findings and guidelines according to the American Cancer Society.   Other articles discuss their reviews to support mammogram screening for women under 50, a systemic review of the benefits and harms of breast cancer screening and factors that influence breast cancer screening in Asian countries. Introduction Currently, breast cancer is one of the most common cancers in women and one of the chief causes of death worldwide. (Oeffinger,Fontham, Etzioni, et al.)   According to the American Cancer Society 2015, it is the leading contributor to cancer mortality in women aged 40 to 55.   Several risk factors increase the likelihood of the disease occurring.   These factors include: (1) aging, (2) personal history of breast cancer, (3) family history of breast cancer, (4) history of benign breast disease, (5) menarche younger than 12 years, (6) nulliparous, or a first child after age 30, (7) higher education or socioeconomic level, (8) obesity and/or high fats diets, (9) menopause after age 50, (10) lengthy exposure to cyclic estrogen and (11) environment exposure (American Cancer Society, 2015).   The cause of breast cancer is still unspecified, yet these risk factors are known to play a part in the risk of developing this disease.   Essentially all women can be considered at risk.   No successful cure or preventative methods exist, and early recognition offers the best opportunity for decreasing morbidity and mortality. Literature Review The first article that I reviewed is titled â€Å"Benefits and Harms of Breast Cancer Screening, A Systemic Review†.   According to Myers, et al., mortality from breast cancer has declined substantially since the 1970’s, a drop attributable to both the accessibility of screening methods, particularly mammography, and better-quality treatment of more advanced cancer.   This literature pointed out that, although there has been stable evidence that screening with mammography reduces breast cancer mortality, there are a number of possible harms, including false-positive results, which result in both needless biopsies and added distress and anxiety associated to the potential diagnosis of cancer.   In addition, screening may lead to over diagnosis of cancers that may not have become life-threatening.   With their investigation in the meta-analyses of RTCs (randomized clinical trials) that stratified by age, screening women younger than 50 years was constantly associated with a statistically significant reduction in breast cancer mortality of approximately 15% while screening women 50 years or older was linked with slightly greater mortality reduction (14-23%).   In general, based on their research, they have concluded that â€Å"regular screening with mammography in women 40 years or older at average risk of breast cancer reduces breast cancer mortality over at least 13 years of follow-up, but there is uncertainty about the magnitude of this association, particularly in the context of current practice in the United States.† In summary, this review concluded that among women of all ages at average risk of breast cancer, screening was related with a reduction in breast cancer mortality of approximately 20%, although there was ambiguity about quantitative estimates of the association of different breast cancer screening strategies in the United States.   These findings and the related uncertainty should be considered when making suggestions based on judgments about the balance of benefits and harms of breast cancer screening. (Myers et al. 2015). Mammography can pinpoint tumors too small to be detected by palpitation of the breast by the woman or her health care provider.   Early detection of breast cancer in women improves the possibility of successful treatment and thus cuts morbidity and mortality from the disease (American Cancer Society, 2015).   Yet, there still exists an observable lack of compliance with the recommended screening guidelines.   According to an article in the Journal of the American College of Radiology by Monticciolo, et al. (2015), they pointed out that previous to the presentation of widespread mammographic screening in the mid-1980s, the mortality rate from breast cancer in the US had stayed unaffected for more than 4 decades.   From 1990, the fatality rate has fallen by at least 38%.   Considerably, this change is recognized to prompt detection with mammography.   In this next article, Miranda-Diaz, et al. (2016) studied the Hispanics Puerto Rican subjects, inner-city women and determinants of breast cancer screening and suggested that women with low incomes and education were less likely to partake in mammography.   Lack of submission of breast cancer screening tests is more prevalent among minorities.   They added that Hispanic women are less likely to receive a Physician’s recommendation for breast cancer screening, therefore, it was the primary reason for not doing a mammogram.   Other barriers for lack of compliance among Hispanic women and Latinas living in California are lack of health insurance, age, usual source of care, having a busy schedule, fear, cost and feeling uncomfortable during the procedure. In conclusion, the authors of this article did a study that was limited by the small sample size and may not be generalizable to the entire population of the island. In order to improve compliance as well as educating health care providers about the importance of referral, a tailored health education interventions directed to describe the nature and benefit of cancer screening test needed to be put in place. Similarly, another article stated that early detection of breast cancer, while the tumor is still small and localized, provides the opportunity for the most effective treatment. (Mandelblatt, Armetta, Yabroff, et al.) According to the American Cancer Society 2015, detection guidelines recommended that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years.   Women aged 45- 54 years should be inspected annually and women 55 years and older should changeover to biennial screening or have the opportunity to begin annual screening between the ages of 40 and 44 years.   The suggested outcome of the guideline would result in earlier detection because breast cancers found by mammography in women in their forties are smaller and more treatable than those found by self-breast exam or clinical breast exam.   Consequently, earlier detection by mammography could save lives. According to an article by Kathy Boltz, Ph.D. (2013), amid the 609 definite breast cancer deaths, 29% were including women who had been screened with mammography, while 71% were among unscreened women.   In tally, her investigation found that of all breast cancer deaths, only 13% happened in women aged 70 years or older, but 50% occurred in women under 50 years old. Her studies were done to support mammogram screening for women under age 50.   In the meantime, Dr. Cady, MD, Professor of Surgery of Harvard Medical School in Boston, Massachusetts, and his teammates set out to deliver complete information on the value of mammography screening through a technique called â€Å"failure analysis†.   Such evaluations look backward from the time of death to determine the connections at diagnosis, rather than looking forward from the start of a study.   Only one other failure analysis related to cancer has been published to date.   In this evaluation, invasive breast cancers analyzed at Partners HealthCare hospitals in Boston between 1990 and 1999 were followed through 2007.   Facts for the study comprised demographics, mammography use, surgical and pathology reports, and recurrence and death dates.   The article also stated that the study showed a dramatic shift in survival from breast cancer associated with the introduction of screening.   In 1969, half of the women diagnosed with breast cancer had died by 12.5 years after diagnosis.   Between the women with aggressive breast cancer in this review who were spotted between 1990 and 1999, only 9.3% had expired.   â€Å"This is a remarkable achievement, and the fact that 71% of the women who died were women who were not participating in screening clearly supports the importance of early detection,† said co-author Daniel Kopans, MD, also of Harvard Medical School. The study of the â€Å"perception of breast cancer risk and screening effectiveness† was studied by Black, Nease, & Tosteson (1995).   The purpose of the study was to determine how women 40-50 years of age perceive their risk of breast cancer and the effectiveness of screening and how these perceptions compare with estimates derived from epidemiologic studies of breast cancer incidence and randomized clinical trials of screening. A random sample of 200 women, age 40-50 years old who had no history of breast cancer was chosen through the computerized medical records of Dartmouth-Hitchcock Medical Center.   Thirty-nine percent had an annual family income of $50,000 to $100,000, and 62% had at least a college education.   The subjects received the questionnaire in the mail which asked questions pertaining to breast cancer risk and screening effectiveness.   Seventy-three percent responded with a complete questionnaire.   The results showed that the women overestimated their probability of dying of breast cancer within ten years by more than twenty times.   When asked about their relative risk reduction from breast cancer screening, they overestimated by six times.   These results are based on assuming a 10% relative risk reduction from cancer screening.   Eighty-eight percent of the subjects agreed that the benefits to screening mammography outweighed the barriers.   The generalizability of this study is very limited because of this population is better educated and of higher income than the general U.S. population of women of the same age range.   Also, the subjects’ breast cancer risk was not precisely known, and the effectiveness of modern screening mammography is unknown.   The limitations also include the questionnaire which has not been previously tested.    The last article is a literature review of â€Å"factors influencing breast cancer screening in Asian countries.†Ã‚   Studies done by Ahmadian and Samah (2012), found that breast cancer arises in the younger age group of Asian women, 40 to 49 years old compared to the other Western counterparts, where the peak prevalence is realized between 50 to 59 years.   According to multiple sources and authors, in Singapore, Malaysia, Iran, Thailand, Pakistan, and Arab women in Palestine, more than half of new cases of breast cancer were diagnosed in women below the age of 50 years and in advanced stages III or IV.     Schwartz et al. (2008), discovered that breast cancer screening activities among Asian women living in their native country are low and mammography screening in Middle Eastern countries are also low.   Analyses of the information have shown that only 23% of Turkish people testified having at least one mammogram.   Fewer women about 10.3% in the United Arab Emirates had mammography, which was attributed to poor knowledge of breast cancer screening and infrequent offering of screening by healthcare workers (Schwartz et al., 2008)   In conclusion of this article, the authors stated that in order to improve women’s participation in breast cancer prevention programs/ screenings, especially among the at-risk subgroup, the intervention strategies should be tailored to their knowledge and socio-demographic factor.   The approaches accepted should also take into account the women’s emotional and ethnic matters in order to support lifelong mammography screening practice for Asian people which is based on hypothetical interventions. In addition, healthcare professionals working with Asian women should cautiously tackle the misapprehensions such as worry about mammogram devices and fatalism. (Ahmadian & Samah, 2012) Conclusion In summary, after reading and reviewing the 6 related articles pertaining to breast cancer and mammogram screening for women under 50, I have concluded that there are both pros and cons, benefits and harms, perceived benefits and alleged barriers, and compliance factors that affect women worldwide. Breast cancer has claimed millions of lives throughout the world and women should be encouraged to be mindful of and to consider their family history and medical history with a physician to determine if early detection is a warrant.   If the woman has an average risk of developing breast cancer, the American Cancer Society supports a discussion of screening around the age of 40 years.   According to the guideline, ACS recommends that women be provided with information about risk factors, risk reduction, and the benefits, limitations, and harms associated with mammography screening.   While it is recognized that there is a balance of risks and benefits to the mammogram, women should be provided with guidance so that they can make the best choice about when to start and stop screening and how frequently to be screened for breast cancer.   So, if you or your loved ones have an average risk of breast cancer and over 40 years old, would you prefer to have a checkup once a year or once every two years?   This is rather a personal choice but with early detection, the benefit of mammogram will prove to outweigh the risk and could possibly save your life. References Ahmadian, M and Samah, A.(2012) A Literature Review of Factors Influencing Breast Cancer Screening in Asian Countries.Life Sci J 2012;9(2):585-594.   (ISSN: 1097-8135).   http://www.lifesciencesite.com.   Accessed January 16, 2018 Breast Cancer Screening and Diagnosis (version 1.2015).   National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdfAccessed January 16, 2018. Mandelblatt, JS, Cronin, KA, Bailey, S, et al. (2009) Breast Cancer Working Group of Cancer   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Intervention and Surveillance Modeling Network.   Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern. Med. 2009;15(10):738-747. Mandeltblatt, JS, Armatta, C, Yabroff, R, Liang, W, Lawrence, W. (2004) Descriptive Review of the Literature on Breast Cancer Outcomes: 1990 Through 2000. JNCI Monographs, Volume 2004, Issue 33, 1 October 2004, Pages 8-44. https://academic.oup.com/jncimono/article/2004/33/8/933605Accessed January 17, 2018. Oeffinger, KC, Fontham, ETH, Etzioni, R, et al. (2015). Breast Cancer Screening for Women at average risk: 2015 Guideline Update from the American Cancer Society. Jama.2015. doi:10.1001/jama.2015.12783. https://provimaging.com/wp-content/uploads/2015/11/JAMA-Network-_-JAMA-_-Breast-Cancer-Screening-for-Women-at-Average-Risk_-20.pdfAccessed January 17, 2018. Schwartz, LM, Woloshin, S, Sox, HC, Fischloff, B, Welch, HG.(2000) US Women’s Attitudes to False Positive Mammography Results and Detection of Ductal Carcinoma in Situ:   Cross Sectional Survey. BMJ. 2000;320 (7250): 1635-1640. http://www.bmj.com/content/320/7250/1635.Accessed January 20, 2018