The Effects Of Climate Change On Our Planet - 1061 Words

I am writing this letter to express my concern about the dangers that climate change poses on our planet. Climate change is occurring much faster than predicted. For that reason, many of our efforts aren’t fixing the issue fast enough. Many scientists agree that climate change will be the death of our people, and the future of our children if not improved by 2050. We only have a few years to reverse the affects climate change has had these past years. The 20 years that I have lived on this earth, there has not been one year where weather was â€Å"normal.† Winters have come to early or late. Low snowfall during the winter, or snow still falling in the spring. When it isn’t snowing, there have been record high temperatures in areas that aren’t supposed to experience such heat. There have also been many accounts of tropical storms and flooding all over the country. These past years have been the years where both humans and animals are negatively affected by these weather related tragedies. Climate change has been the culprit in global warming which in turn has decreased the animal populations due to the warming of the earth. Climate change has already caused the planet’s average temperature to rise by 1.6 °F since the beginning of the 20th century. That temperature rise could reach 2.7 °F above pre-industrial levels by the end of the century (and possibly as high as about 8.5 °F above 1986-2005 levels) if nothing is done to curb emissions. (Thompson, 2014) Climate change has such aShow MoreRelatedThe Effects Of Climate Change On Our Planet1172 Words   |  5 PagesClimate is the weather conditions over a long term. For millions of years, the earth kept changing between hot and cold, and wet and dry. As the earth warmed and cooled, plants and animals appeared and disappeared. People have had to change their way of life many times as plant and animal life changed. Since the industrial revolution, the humans built many factories and invented lots of electro nic devices. They emit harmful gases called greenhouse gases like carbon dioxides and ozone, which affectsRead MoreEffects Of Climate Change On Our Planet1372 Words   |  6 PagesSolution to Climate Change Climate change has taken its toll on our planet. Record heat, fires, drought and snowstorms have all become the norm in our worldwide weather patterns. The city of Charlotte has also suffered from the consequences of climate change with extreme temperatures, record snowstorms and ice storms. It is apparent that action must be taken immediately to stop climate change (Sargent). How can a small city attempt to solve a global issue such as climate change? Can climate changeRead MoreClimate Change Is A Serious Problem1123 Words   |  5 PagesClimate Change is a Serious Problem to the Planet â€Å"Climate change is happening, humans are causing it, and I think it is perhaps the most serious environmental issue facing us.† This quote from Bill Nye illustrates the serious nature of climate change. Climate change is the most serious issue that is plaguing the world. Global temperatures have been increasing in recent years and it is clear that our climate is changing. Climate change is the change of temperature and weather in our environmentRead MoreClimate Change Is A Real Threat1105 Words   |  5 PagesClimate Change is a Real Threat â€Å"Climate change is happening, humans are causing it, and I think it is perhaps the most serious environmental issue facing us.† This quote from Bill Nye illustrates the serious nature of climate change. Climate change is the most serious issue that is plaguing the world. Global temperatures have been increasing in recent years and it is clear that our climate is changing. Climate change is the change of temperature of our environment. A majority of scientists suspectRead MoreThe Issue Of Global Warming1338 Words   |  6 Pagesrising average global temperature. The climate on the Earth is changing and there is no big surprise. It is believed that global warming is caused by many natural and manmade activities, which is affecting the planet by the seconds, minutes, hours, days, and years. Many may not even care about this serious issue, but others harm for the future generations. Global warming has become a serious threat to everything and every human being on earth and demands our immediate attention. The author, StuartRead MoreCauses And Effects Of Climate Change Essay1260 Words   |  6 PagesCommunication 11, Section D23 Informative Speech 14 November 2016 Causes and effects of Climate Change. General purpose: to inform. Specific purpose: After hearing my speech, my audience will know more what climate change is, what causes it and its effects now and in the future. Thesis Statement: Climate change is a very important issue that affects all of us, we need to know more about this issue. Organization pattern: Cause and effect. Introduction: I. (Attention-getter): When you look at yourself in aRead MoreCause And Effect Of Climate Change Essay1220 Words   |  5 PagesCause and effects of Climate Change. General purpose: to inform. Specific purpose: After hearing my speech my audience will know what climate change is, what causes it and its effects now and in the future. Thesis Statement: Climate change is a very important issue that affects all of us. Organization pattern: Cause and effect. Introduction: I. (Attention-getter): How do you explain that 30 years ago we had a different weather than today? When you look at yourself in a dirty mirror; can you seeRead MoreClimate Change : The Planet1227 Words   |  5 PagesClimate Change The planet that is our home never ceases to amaze mankind with its seemingly never-ending mysteries. Home to about 8.7 million various species that roam the globe; the Planet Earth is considerably the most habituated planet in our solar system. Despite numerous attempts to research the other fellow planets in our system, it appears that many drastic changes have been taking place on our home planet. From the evolution of plants and animals, to the advancements in modern technologyRead MoreGlobal Warming And Climate Change1124 Words   |  5 Pagesquestion that climate change is happening; the only arguable point is what part humans are playing in it.† Climate change is a pending issue waiting to be addressed and resolved by society as a whole before it is too late. Statistics show that the United States contains only 5 percent of the world s population, but contributes 22 percent of the world s carbon emissions. During the 21st century, global warming is expected to continue and climate changes are likely to increase, including: changes in temperatureRead MoreArctic Climate Change919 Words   |  4 PagesChanges in the Arctic climate will not only affect the animals, plants and people living in the Arctic regions, but it will also affect the rest of the world. The Arctic region is made up of the northern parts of Canada, the United States, Greenland, Iceland and the Eurasian continents. The changes in the climate will increase global warming in these countries causing the sea level to rise all around the world. Here is how the climate has been changing in the Arctic. This evidence of this change

Frankenstein Abandonment Essay - 1166 Words

Frankenchild: Critical Analysis Paper Abandonment indicates a parent’s choice to have no part in his or her offspring’s life. This includes failure to support the child financially and emotionally, as well as failure to develop a relationship with his or her child. Sadly, parental abandonment leaves a child with doubt and uncertainty about the future. Throughout his or her life, this particular child could suffer from lasting questions of self-worth. In the opposite direction, the child could learn to resent his or her parents and remain incapable of trusting anyone. Regardless, intentional negligence of children leaves them with an unbearable pain that they must carry around for the rest of their lives. Child-care and the consequences†¦show more content†¦The first lesson the monster ever learned came from Victor Frankenstein. Whenever the monster turned to his master for love and comfort, he was turned away with fear. As soon as Frankenstein saw his repulsi ve countenance, he ran away into the dark of the night. Right away, the monster was denied any form of nurture that could have potentially changed the plot of the novel. After stumbling upon a few unpleasant strangers, the monster only desired acceptance from human society with the help of the cottagers: â€Å"The more I saw of them, the greater became my desire to claim their protection and kindness; my heart yearned to be loved and known by these amiable creatures (Shelley, 133).† Some parents such as Victor begin ignoring their children from the very beginning. If kids don’t receive nurture from an early age, their personalities are shaped by the way they are treated: â€Å"These family disruptions are much more strongly related to feelings of fewer social supports and more negative moods and feelings (Science Blog).† Without guidance from his â€Å"father†, the monster attempted to make a place for himself into society. The monster’s heroic re scue of the little girl illustrates his good heart and innocence; even though his mind was slightly disturbed, all he needed was for someone to reciprocate his love. Giving undying support to a child is detrimental to their development. Parents play a huge role in their child’s life and should be present as much asShow MoreRelatedFrankenstein: Abandonment, Loneliness, and Rejection1422 Words   |  6 Pagesfaulty natures,† writes the narrator of Mary Shelley’s novel, Frankenstein, Dr. Frankenstein. Without a companion of some sort, people will only suffer more. However, without the supervision of parents, children altogether are greatly affected for the rest of their lives. An innately good and sympathetic creature, Dr. Frankenstein’s monster struggles to survive in the human world. After creating and abandoning his creature, Dr. Frankenstein is the juxtaposition of a monster, portraying humans as shallowRead MoreRejection And Abandonment Of Mary Shelley s Frankenstein1191 Words   |  5 Pages2015 Frankenstein Essay Rejection is a hard thing to overcome. Rejection and abandonment can happen to newborn babies, children, and adults. Some babies are abandoned due to birth defects; children and adults are bullied and rejected because of the clothes they wear, their hair, face, ethnicity, and body. Some of this rejection can go too far, and can cause the one being bullied to become suicidal, or even homicidal. The theme of rejection is apparent in Mary Shelley’s novel, Frankenstein. IsolationRead MorePoor Parenting Revealed in Mary Shelleys Frankenstein Essay1090 Words   |  5 Pages Victor Frankenstein, does not live up to his role model. He lacks compassion for his creation (Madigan 3)    A predominant theme in Mary Shelley’s Frankenstein is that of child-rearing and/or parenting techniques.   Specifically, the novel presents a theory concerning the negative impact on children from the absence of nurturing and motherly love.   To demonstrate this theory, Shelly focuses on Victor Frankenstein’s experimenting with nature, which results in the life of his creature, orRead MoreFrankenstein Literary Analysis Essay903 Words   |  4 PagesFrankenstein Literary Analysis Friends will determine the direction and quality of your life. Loneliness is a battle that all people will once face at a certain point in their life; it is how they handle it that determines the outcome of that battle. In Mary Shelleys Frankenstein loneliness is the most significant and prevailing theme throughout the entire novel. Shelley takes her readers on a wild journey that shows how loneliness can end in tragedy. Robert Walton is the first characterRead MoreNature Vs. Nurture in Mary Shelley ´s Frankenstein1008 Words   |  4 Pageswas coined, Mary Shelley’s 1818 novel, Frankenstein, explored the idea of nature vs. nurture in the context of creation. The greatest exemplification of Nature vs. Nurture in Frankenstein is explored in the fate of the Creature, who begins his life a seemingly pure creation but eventually involves himself in violent revenge against his creator, Frankenstein. The examination of the Creature’s character must include an overall evaluation of the role Frankenstein had in his life, or lack there of. WithinRead MoreMary Shelley s A Vindication Of The Rights Of Women1131 Words   |  5 PagesThe notion of what it means to be human is heavily addressed in Mary Shelley’s Frankenstein, as Victor Frankenstein, the eponymous character, produces a creature that resembles a human in both an internal and external sense. Despite the creature’s obvio us human-like qualities, society rejects him continuously. To some extent, this blatant disregard resembles the difficulties that accompanied the feminist movement. Mary Shelley’s mother, Mary Wollstonecraft, wrote A Vindication of the Rights of WomenRead More Look at the significance of chapter five to the novel as a whole.1126 Words   |  5 Pageseffect of the writer’s language to describe setting, character and what it shows about social and historical influences. Frankenstein is a Victorian novel written in the gothic genre. It is about a man, Victor Frankenstein, giving life to an inanimate being and abandoning it. The monster then seeks revenge and the love of what he believes to be his mother, Frankenstein. The author, Mary Shelley, wrote the book at the age of nineteen but was not able to get the book published at first, asRead MoreThe Real Monster in Frankestein by Mary Shelley1000 Words   |  4 PagesIn most readers’ minds, there seems to be no doubt as to who the real monster is in Frankenstein. The definition of the word â€Å"monster† is â€Å"any fictional creature, usually found in legends or horror fiction that is often hideous and may produce fear or physical harm by either its appearance or its actions† (Powell, 182). The creature that Frankenstein created was not only physically hideous but also murdered many innocent human beings. However, when we look beyond his physical appearance and startRead MoreThe Cruelty Of Mary Shelley s Frankenstein1508 Words   |  7 Pageshumans still persecute others who are different. All in all, the exclusion is a form of bullying. In her novel Frankenstein, Mary Shelley exemplifies these phenomenas of human behavior, when she shows the maltreatment Frankenstein’s monster is giv en for his unattractive physical features and how he attempts to communicate with others in order to terminate his isolation. Victor Frankenstein, engulfed in the dedication of creating a god like image of himself, resurrects life into a eclectic dead bodyRead MoreFrankenstein Essay1176 Words   |  5 Pagesthat 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

Avarice in the Crucible Free Essays

Cambria Anderson Petersen AP English III/Period 3 11 November 2012 Avarice and Vengeance in The Crucible The play The Crucible takes place during the Salem Witch Trials of the 1800s. Yet Arthur Miller does not reveal the tragedy of the witch trials in the manner expected. We will write a custom essay sample on Avarice in the Crucible or any similar topic only for you Order Now Miller expresses the underlying causes of the accusations made as those stemming from personal greed and the feeling of revenge. Abigail Williams, Mr. and Mrs. Putnam, and Reverend Samuel Parris all have their own agendas as to why they â€Å"cry witch† on others in their village. Miller outlines the history between Abigail Williams and John Proctor in Act One: Abigail was removed from the Proctor home by Elizabeth, Proctor’s wife, because of an affair happening between her and Proctor. Because of this, Abigail harbors a hate and jealousy towards Elizabeth. In Act Two, a warrant was sent for Elizabeth’s arrest: The girl, the Williams girl, Abigail Williams, sir. She sat to dinner in Reverend Parris’ house tonight, and without word nor warnin’ she falls to the floor. Like a struck beast, [Parris] says, and screamed a scream that a bull would weep to hear. And [Parris] goes to save her, and, stuck two inches in the flesh of her belly, he draw a needle out. And demandin’ of her how she come to be so stabbed, she [†¦] testify it were your wife’s familiar spirit pushed it in. (Miller 79) Abigail knew that from the beginning of the witch scare that she could exact revenge on those who she felt wronged her or took something from her, which would be the case of Elizabeth. Abigail knew Mary Warren made a doll, and was planning to give it to Elizabeth; she also saw Mary Warren stick the needle back in. Abigail took advantage of the situation to provide seemingly irrefutable evidence of witchcraft on Elizabeth’s part. Through this, Proctor sees that vengeance runs these trials, and how easily people turn on one another to get what they want. Proctor also knows that Abigail’s revenge has no limits; she has no shame, and always believes that she is right, much like the character of her uncle, Reverend Parris. At this point, Proctor had to juggle keeping his past a secret from the public and protecting Elizabeth, as Abigail will turn on anyone who â€Å"wrongs† her. Mr. Thomas Putnam and Mrs. Ann Putnam have a sorrowful history of losing their newborn children, while only having one that survives. Mrs. Putnam finds comfort in blaming their midwife, Sarah Osburn, for the deaths, saying, â€Å"I begged [Thomas] not to call Osburn because I feared her. My babies always shriveled in her hands! (I. 50). Mrs. Putnam finds that crying witch on Goody Osburn would solve the â€Å"murder† of her children, yet does not desire to take into account her own role in her pregnancy, being that Miller says she is fourty-five years old (I. 13). Mrs. Putnam, in a way, wants someone to feel the pain of losing seven children, being that she is a selfish woman – putting her child in the dangers of witchcraft to find the identity of the person who â€Å"killed† her babies. Accusing someone of witchcraft, and potentially running their life, was the perfect way to exact her so-called â€Å"revenge†. Although Reverend Parris never accused anyone of witchcraft, he refuses to defend Proctor of any charges brought up against him – from insulting the court to claims of witchcraft. In Act Three, Parris takes Proctor’s depositions from Corey Giles and Mary Warren personally, warning Judge Danforth that â€Å"[†¦] since [he] come to Salem [Proctor] is blackening [his] name [†¦]† (110) and â€Å"[Proctor]’s come to overthrow this court, Your Honor! (97). Aside from trying to protect his reputation, Parris makes such allegations about Proctor in an attempt to prove Proctor as an unreliable messenger. Parris wants to get vengeance for what he feels Proctor has done to him, just as Abigail wants revenge on Elizabeth. But, these alleged wrong-doings have only come from Parris’s mouth; he seems to enjoy taking thing s personal when they come from Proctor, and the courtroom scene is the perfect place for Parris to return the hate he feels from Proctor. The Salem Witch Trials proved to be a time of tragedy and mass hysteria as accusations ran rapidly through the small Massachusetts village. The source of the witchcraft charges came from the village people’s personal greed and want of retribution, as well as many other contributing factors. Abigail, Parris, and the Putnams all used this situation to their advantage, hoping to get some personal satisfaction out of their charges, thus ruining lives of their victims: Elizabeth Proctor, John Proctor, and Sarah Osburn. How to cite Avarice in the Crucible, Essay examples

A Comparison on Philippine and Indonesian Educational Systems free essay sample

Education is not preparation for life; education is life itself. † – John Dewey Education is a self-enlightening process that is crucial to the overall development of an individual and the society at large. However, in two ASEAN nations, there still seems to be some shortcomings in the education sector. There are three issues in the education system of both Indonesia and Philippines that will be discussed and compared: quality, affordability of education, and budget. Philippines has revised its educational system only recently, making the compulsory years of education twelve instead of ten. With this change is the adjustment of the curriculum. All subjects under all the general topics of education, language and literature, natural sciences, social sciences, arts, and humanities will be taught from first grade to twelfth grade with the exception of chemistry for first grade to ninth grade. However, even with this curriculum, there is still a decline in the quality of education. We will write a custom essay sample on A Comparison on Philippine and Indonesian Educational Systems or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The results of standard tests among the students, as well as in the National College Entrance Examination for college students, were below the target mean score. This decline can be partly attributed to the shortage of teachers with the 2013 public schools teacher-student ratio of 1:36. Another problem in the Philippine educational system is the affordability of education. There is a big disparity in educational achievements across social groups. For example, the socioeconomically disadvantaged students have higher dropout rates, especially in the elementary level. And most of the freshmen students at the tertiary level come from relatively well-off families. Another problem is the insufficient budget allotted for education by the government. The Philippine Constitution has mandated the government to allocate the highest proportion of its budget to education. However, the Philippines still has one of the lowest budget allocations to education among the ASEAN countries. With this root problem, public schools face the difficulty brought by poor facilities, underpaid teachers, insufficient reading materials and others. Finally, looking in the pragmatic level, there is an educational and employment mismatch. There is a large proportion of mismatch between training and actual jobs. This is the major problem at the tertiary level and it is also the cause of the existence of a large group of educated unemployed or underemployed. According to McKinsey’s Education to Employment study, only 42 percent of worldwide employers believe new graduates are adequately prepared for work. As for Indonesia, it has the fourth largest education system in the world. An assessment of the quality of education in Indonesia, a landmark education report of 50 nations was conducted and Indonesia ranked last. It is unfortunate how the education system does not benefit the youth in a middle income country, as assessed by the World Bank. Another major problem of the Indonesian education system is its low completion rate. Only a third of Indonesian students – in a country where 57 million attend school – complete basic schooling. This is an evidence of the low affordability of education in Indonesia. A lot of problems in the education sector in Indonesia arise from its inadequacy of budget. Because of this, education experts say less than half of the country’s teachers possess even the minimum qualifications to teach properly ad teacher absenteeism hovers at around 20 percent. Many teachers in the public school system work outside of the classroom to improve their incomes. A possible agent in this budget shortage is corruption. Indonesian Corruption Watch claims there are very few schools in the country that are clean of graft, bribery or embezzlement – with 40 percent of their budget siphoned off before it reaches the classroom. This problem is also not unknown in the Philippines. Finally, looking in the pragmatic level, there is an educational and employment mismatch. There is a large proportion of mismatch between training and actual jobs. This is the major problem at the tertiary level and it is also the cause of the existence of a large group of educated unemployed or underemployed. According to McKinsey’s Education to Employment study, only 42 percent of worldwide employers believe new graduates are adequately prepared for work. With this, we see the threatening consequences of a poor education system to the society, a common plight in Indonesia and the Philippines.

50 Synonyms and Idioms for Give

50 Synonyms and Idioms for Give 50 Synonyms and Idioms for â€Å"Give† 50 Synonyms and Idioms for â€Å"Give† By Mark Nichol It’s better to give than to receive, and it’s easier to precisely describe giving than receiving, thanks to numerous synonyms for give. Here are dozens of them, with connotative definitions. 1. Accord: to give what is due 2. Administer: to give medication, to perform a religious ritual, or to carry out a punishment 3. Afford: to give in a manner consistent with the giver, usually something inanimate (for example, â€Å"The complication afforded us additional time to prepare†) 4. Allot: to give a portion or share, or by lottery 5. Apportion: to give in shares 6. Award: to give something that is deserved 7. Bestow: to give as a gift, with the possible connotation of condescension 8. Chip in: see contribute 9. Comp: to give something free that is normally paid for (a truncation of complimentary) 10. Confer: to give graciously 11. Contribute: to give among other providers or supporters 12. Convey: to give something originating from one party to another party 13. Deliver: to give something to the intended recipient 14. Devote: to give something useful or valuable 15. Dispense: see administer and allot 16. Dish out: to give criticism; also see administer and allot 17. Distribute: to give to a number of recipients 18. Dole (out): to give in small amounts 19. Donate: to give to an organization or other entity as an act of charity 20. Endow: to give an income to someone, or to give money for long-term maintenance or support 21. Endue (or indue): see endow and provide 22. Extend: to give so as to make available; see also proffer 23. Fork over (or fork out or fork up): to give money 24. Furnish: see provide and supply 25. Grant: to give consent or to concede; see also bestow and transfer 26. Hand down: to give an inheritance, either of material goods or of characteristics 27. Hand out: to distribute 28. Hand over: to give something intended for or due to another 29. Impart: to give from a supply 30. Kick in: see contribute 31. Lavish: to give generously 32. Mete (out): see dole (out) 33. Offer: to make available, or to give an exhibition or performance 34. Pay: to give in exchange for a product or a service, or to give or forfeit as penalty, or to give something intangible such as attention 35. Pitch in: see contribute 36. Present: to give in a ceremonial or formal manner 37. Produce: see offer 38. Proffer: see offer and tender 39. Provide: to make available 40. Pungle (up): see contribute and pay 41. Render: to give in return or retribution; see also administer, deliver, pay, and yield 42. Reward: to give in return for a service 43. Sacrifice: to give something at a loss or to give something for a belief or an ideal or for a purpose 44. Supply: see provide 45. Tender: to give something that is to be accepted 46. Transfer: see convey 47. Transmit: see convey 48. Volunteer: to give services freely 49. Vouchsafe: to give a reply, or to grant as a favor or privilege; see also bestow 50. Yield: to give as is appropriate or required, or to surrender oneself or a possession Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:Grammar Test 1"Wracking" or "Racking" Your Brain?Prepositions to Die With

Deadmans Underwear Essay Example

Deadmans Underwear Essay Example Deadmans Underwear Essay Deadmans Underwear Essay Deadmans Underwear Bryana Urbanek Ms. Hall English 101 1117/2013 Life Turned Upside Down Last night I wore a deadmans underwear. I dont know how it happened. Everything was so perfect, in a moment I saw a vision of my life. It was exactly how I wanted it to be. A house out in the middle of the desert somewhere; plenty of horses to ride, cows to milk, and chickens to feed. But most importantly, he was there right by my side the entire time. One moment we would be together for the rest of our ives and in the next, he was gone. All it took was a moment, 56 seconds, less than a minute. Thats how long it took for me to get up off the couch, walk into the kitchen, grab a couple beers from the fridge, open them, hear gasping coming from my fianc? ©s direction followed by the sound of glass shattering and my footprints harshly hitting the ground as I ran back to find his shaking body. Face blue, still gasping for any single little breath he could find, eyes rolled back inside his head, body twitching n quick awkward movements and I was completely clueless as to how I could help him. Heart racing I called for an ambulance; they arrived shortly and took him to the hospital. The seizing stopped mid way, unfortunately, his consciousness was never regained. Soon after our arrival, his heart stopped. No paramedic or doctor could bring him back. So there I was, standing over his dead body lying in that hospital bed, hearing the doctors explain how he died from a brain hemorrhage and how there as nothing they could have done, or that I could have done, to have seen it coming. And in that moment, looking at this pale stranger, all I could think of was how I wish I grabbed some pants before I left the house. All that I could resurface about my current predicament was how ridiculous I must look leaning over this shell of a man that I once surrounded my life upon wearing nothing but an undershirt and his pair of lucky charmed boxers. How silly I must have looked in that deadmans underwear.

Poverty-Inequality Reduction in India Term Paper

Poverty-Inequality Reduction in India - Term Paper Example With about two third of the population living in the rural area, even urban poverty stems from the rural migration to the city. This paper is to take as through the various ways taken by the government in trying to reduce poverty. Besides, a person should be in a position to understand the poverty and inequality experienced in India. In addition, it is vital to understand the human poverty in India for the proper understanding of the topic of poverty inequality reduction in India. India has been experiencing a less impressive growth when compared to China; however, compared with other developing countries the economic growth in India has been more impressing. The GPD of India has been on the rise for the last two decades. One of the major attributes to this growth in GDP, is based on the fact that India has experienced a reduction in population growth. In increase in the per Capita and the GDP has been linked to the amount of structural change (Ghosh, Madhusudan, pg 3). The rate of investment has increased over time. This situation has made India to have an increase in per capita growth, and this stands to about 36% increase, from the periods of 1990s. At the same time, the GDP level of Agriculture has decreased and is now found on the predictable line. However, not all sectors have experienced some economic growth or development. For instance, since 1990s, the secondary sector has not experienced some growth. On the sector of the tertiary sector, really incr eased and now accounts for almost half of the income of the nation. The change experienced in the output shares did not go hand in hand with an equal change in the workforce distribution. This has been continuing despite of the reduction on the agricultural share and the collapse of employment generated from agricultural in the current decades. For the last two decades, the investment high rate has not contributed to a grater

TECHNIQUES FOR THE PREVENTION OF SOFTWARE PIRACY Essay

TECHNIQUES FOR THE PREVENTION OF SOFTWARE PIRACY - Essay Example You need to add a specific section on Scope (break Aim and Scope into 2 distinct sections – Aim and Objectives, and Scope). Aim and Objectives must have a specific Aim and then Objectives to achieve the Aim. Scope should include that you are only considering; 1 YOU NEED TO WORK ON THIS1. Section 2.1-> You state that both qualitative and quantitative methods were employed to deduce the facts. Firstly this section states how the work is to be done so you should change the tense of everything in this section to read ‘are to be employed’. Secondly you need to explain more specifically which methods you employed fall into these categories. 3 OK2. Section 2.2. -> You must add some critical assessment of techniques. Currently only good points selected for web and email. Comparison and contrast required. What other techniques are available and why did you choose email against them. What are the potential limitations of email? 1 4. Section 2.4. -> You should rethink validation of the framework. How are you going to test the basis of the framework? For example, you identify factors from literature, but are all the relevant factors currently included? 1 OKa. You state that ‘This research to analyse the various types of software piracy that are briefed above †¦Ã¢â‚¬â„¢. Where is this analysis in the work? Either reword this sentence or add the analysis. 1 OKa. Cost towards bottom of page. Is this per seat or development costs? You need to provide a better discussion of cost and understand the specific types of cost which might be incurred. Cost is too broad a heading. 1 a. Time Limitation -> this is not a technology but a feature. Many of the technologies can include this feature. This should be discussed as a potential feature and then the technologies reviewed against the feature i.e. can they support it? This will also require changes to the framework. 2 YOU NEED TO WORK ON THISb. Each choice node requires some discussion,

Special Interests Essay Example | Topics and Well Written Essays - 1750 words

Special Interests - Essay Example They work to elect politicians who can understand their cause and have sympathy for them. Also the role is to involve people who can conduct secret and at times, open propaganda campaigns. There are a number of interest groups prevalent within any society. These comprise of the economic associations which can include trade unions, chambers of commerce and industries and some religious bodies. Then there are the professional associations which have within their fore architects, doctors, lawyers and certain other professionals (Tilt, 1994). The third type of interest group is made up of public interest groups where the inclusion is of friends of environment with a single aim towards benefiting people beyond their mere memberships. The fourth is a special interest group which is essentially a subgroup that is formed within the framework of a bigger group and that emphasizes upon a narrow interest scope. Interest groups try their best to defend a status quo and to maintain it over a peri od of time. It is for this reason that interest groups are hailed differently from the pressure groups. These interest groups have a properly defined intention behind their formation and this is the reason why they are openly advocated for by their proponents and supporters. These individuals feel that these interest groups represent what they would like to suggest to all and sundry, as well as depict the truest picture for their own sake as far as the societal manifestations are concerned. Interest groups are always seen with an eye of skepticism because they have their own intentions to look after. Moreover, the manner under which they exist raise quite a few opinions on the part of the people. Some of the examples related with these interest groups are the National Rifle Association (NRA), People for the Ethical Treatment of Animals (PETA) and many more. These interest groups rely on the people within the society to make up their vital opinion and hence come forward. As a case in point, NRA has an interest within the opposition of anything that is anti-arm and is thus a complete defender of the Second Amendment’s rights (Kleiner, 2002). On the other hand, PETA empathizes with the animals and solicits the response of the people within a community to come up with ethical solutions so that moral grounds could be founded for the animals in order for their survival domains (Pizam, 2008). Hence the role of these interest groups is of immense significance within this day and age as they mold public opinion and look to form a basis for critical issues that plague a society in one way or the other. It would be true on the part of the society to liaise with the interest groups so that the collective endeavors can have a long-lasting impact on the realms of the society and its inmates can heave a sigh of relief from the pressing issues, cropping up every now and then. There are a number of examples with regards to these interest groups but what remains importan t is their effort to set things right within the terrains of a society. If this happens, then interest groups will serve their purpose well. However, if this is not done in an adequate manner, then there are serious concerns with their formation in the first place. 2. Discuss the relationship between interest groups and political parties. The relationship between interest groups and political parties is one of significance.  

Permanent Vascular Access For Hemodialysis Health And Social Care Essay

Permanent Vascular Access For Hemodialysis Health And Social Care Essay Introduction: A progressive rise in the number of patients accepted for renal replacement therapy has been reported world wide . Permanent vascular access (VA) is the life-line for the majority of these patients, when hemodialysis is the treatment of choice. Thus, the successful creation of permanent vascular access and the appropriate management to decrease the complications is mandatory. A well functional access is also vital in order to deliver adequate hemodialysis therapy in end stage renal disease (ESRD) patients. Unfortunately, despite the advances in hemodialysis technology, in the field of vascular access in the last years the introduction of the polytetrafluoroethylene (PTFE) graft and the cuffed double lumen silicone catheter were the only changes. But the cost of vascular access related care was found to be more than fivefold higher for patients with arteriovenous graft (AVG) compared with patients with a functioning arteriovenous fistula (AVF) . It seems that the native arteriovenous fistula that Brescia and Cimino described in 1966 still remains the first choice VA . Thereafter, vascular access still remains the Achilles heel of the procedure and hemodialysis vascular access dysfunction is one of the most important causes of morbidity in this population . It has been estimated that vascular access dysfunction is responsible for 20% of all hospitalizations and the annual cost of placing and looking after dialysis vascular access in the United States exceeds 1 billion dollars per year . Nowadays, three types of permanent vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and cuffed central venous catheters. They all have to be able to provide enough blood flow in order to deliver adequate hemodialysis, have a long use-life and low rate of complications. The native forearm arteriovenous fistulas (AVF) have the longest survival and require the fewest interventions. For this reason the forearm AV, is the first choice, fol lowing by the upper-arm AVF, the arteriovenous graft (AVG) and the cuffed central venous catheter as a final step . History of vascular access Vascular access for hemodialysis is closely associated with the history of dialysis. Glass needles were employed as vascular access when hemodialysis came into view in 1924. The first haemodialysis treatment in humans was carried out by Haas G who used glass cannulae to acquire blood from the radial artery and reverting it to the cubital vein . Venipuncture needles were used as means for blood acquisition from the femoral artery and its reinfusion to patient by vein puncture, in 1943 by Kolff W. . Regular hemodialysis treatments were possible in 1950s through the use of a medical apparatus ( Kolff s twin-coil kidney ), thus projecting the problem of a reliable, capable of repeated use vascular access. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1952, Aubaniac had described the puncture of the subclavian vein . In the 60s, by using Alwalls experience, Quinton, Dillard and Scribner developed arteriovenous Teflon shunt . This procedure involved two thin-walled Teflon cannulas with tapered ends were inserted near the wrist in the forearm, one into the radial artery and the other into the adjacent cephalic vein. The external ends were connected by a curved Teflon bypass tube. Later, the Teflon tube was replaced by flexible silicon rubber tubing. After the advancement of permanent vascular access, the possibility of maintenance hemodialysis was a fact and therefore a groundbreaking procedure. In the subsequent years many variants of the AV shunt were used, with the majority of them concerning temporary vascular access from the onset of chronic dialysis treatment compensating for the time of AV fistulas absence or maturity. In 1961, Shaldon performed hemodialysis procedures by inserting catheters into femoral artery and vein, using the Seldinger-technique . Over time, vessels in different sites were used, including the subclavian vein jugular and femoral. In 1962 Cimino and Brescia described a simple venipuncture for hemodialysis . In 1963 Thomas J. Fogarty invented an intravascular catheter with an inflatable balloon at its distal tip designed for embolectomy and thrombectomy . The first surgically created fistula was placed in 1965, followed by further 14 operations in 1966. In 1966 Brescia, Cimino, Appel and Hurwich published their paper about arteriovenous fistula. Appell had performed a side-to-side-anastomosis between the radial artery and the cephalic antebrachial vein. One year later, in 1967, M. Sperling reported the successful creation of an end-to-end-anastomosis between the radial artery and the cephalic antebrachial vein in the forearm of 15 patients using a stapler . In the next few years this type of AV anastomosis received popular approval. However this procedure was cast aside as first choice AV, due to the increasing numbers of elderly, hypertensive and diabetic patients with demanding vessels and high risk of a stea l syndrome. End-to-end-anastomoses are still a common place technique in revision procedures. In 1968 Rà ¶hl L. published thirty radial-artery-side-to-vein-end anastomoses . After anastomosis was performed, the radial artery was ligated distal to the anastomosis, thus resulting in a functional end-to end-anastomosis. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1970, Girardet R. and Brittinger W.D. described their experience with the femoral vein and artery for chronic hemodialysis. Experimental trials have been done by several authors in order to establish a permanent vascular access using subcutaneous tunnel. Brittinger W. was the first to implant a plastic valve as a vascular access in an animal model but unfortunately his efforts did not proceed to a human one . Moreover during the early 70s, Buselmeier T.J. developed a U-shaped silastic prosthetic AV shunt with either one or two Teflon plugged outlets which communicated to the outside of the body. The U-shaped portion could be totally or partially implanted subcutaneously . Subsequ ently pediatric hemodialysis patients were extremely favored by this procedure. New materials for AV grafts were presented in 1972, one biologic and two synthetic.. In 1976, L.D. Baker Jr. presented the first results with expanded PTFE grafts in 72 haemodialysis patients . In the years to come several publications indicated the benefits and the shortcomings of the prosthetic material in question remaining the primary choice of graft for hemodialysis VA to date. The same year two authors, Mindich B. and Dardik H. had worked with a new graft material: the human umbilical cord vein. . Regrettably so, this material did not succeed in becoming a revolutionary graft material due to its inadequate resistance against the trauma of repeated cannulation and their complication (aneurysm and infection). After the subclavian route for haemodialysis access was firstly introduced by Shaldon in 1961, it was further processed in 1969 by Josef Erben, using the intraclavicular route . In the next 20 y ears or so, the subclavian vein was the preferred access for temporary vascular access by central venous catheterization. Today, due to phlebographic studies revealing a 50% stenosis or occlusion rate at the cannulation site, subclavian route has been discarded. The subclavian stenosis and occlusion predispose to oedema of the arm, especially after creation of an AV fistula . The first angioplasty described by Dotter et al who introduced a type of balloon, was immensely conducive to the resolution of one of the most significant predicaments in vascular surgery and vascular access surgery . In 1977 Gracz K.C. et al created the proximal forearm fistula for maintenance hemodialysis, a variant of an AV anastomosis . An adjustment of this AVF became quite significant in the old, hypertensive and diabetic patients on the grounds that it allows s a proximal anastomosis with a low risk of hypercirculation . In 1979 Golding A.L. et al developed a carbon transcutaneous hemodialysis access device (CATD), commonly known as button, as a blood access not requiring needle puncture . As a procedure of third choice, these devices were expensive and never gained widespread acceptance. Shapiro F.L. described another type of A.L. button, a device similar to that developed by Golding . Angioaccess classification Years after the initial efforts to create the appropriate vascular access in order to perform a safe hemodialysis, modern Nephrologists have now the possibility to select the appropriate access for their patients. So the first distinction is made between temporary and permanent VA . Temporary VA with expected half-life less than 90 days, peripheral arteriovenous shunts and non cuffed double lumen catheters are included . Mid-term VA with expected half life in 3 months to 3 years include veno-venous accesses (tunneled cuffed catheters and port catheter devices) and arteriovenous internal shunts, requiring vascular graft synthetic (PTFE) or biologic (saphenous vein, Procol, etc.) material ,or external shunt. Long-term VA with an expected half-life more than 3 years includes virtually the native arteriovenous fistulas and the new generation of PTFE grafts . Acute hemodialysis vascular access They are used for urgent hemodialysis and should be easy to insert and available for immediate use. Currently there are available two types of such accesses: Non-tunneled dialysis catheters and cuffed, tunnelled dialysis catheters. Double-lumen, non-cuffed, non-tunnelled hemodialysis catheters are the preferred method for immediate hemodialysis when a long term access is not available. They are made of polymers which are rigid at room temperature to facilitate insertion but soften at body temperature to minimize vessel injury and blood vessel laceration. The proximal and distal lumens should be separated by at least 2 cm to minimize recirculation . These catheters can be inserted into the central veins: femoral, jugular, or subclavian veins . The femoral artery can be used as an access central vein when all others central veins have been excluded. A modified Seldinger guide wire technique is used for their insertion. Image guided assistance in placing these catheters is recommended to avoid or minimize some of the immediate insertion complications, but non-cuffed catheters are also suitable for use at the bedside of the patient The 2006 National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines recommend, after internal jugular or subclavian vein insertion, identifying radiographically any potential complications and confirming tip placement prior to either anticoagulation or catheter use . These guidelines also recommend ultrasound vessel identification prior to insertion. In general, now the subclavian catheters should be avoided because of the high incidence of vein stenosis and thrombosis. The maximum blood flow with this class of catheters is usually blood pump speeds of 300 mL/min, with an actual blood flow of 250 mL/min or less . Femoral catheters have to be at least 18 to 25 cm in length in order to have lower recirculation. The routine use-life of these catheters varies by site of insertion. In general, internal jugular catheters are suitable for two to three weeks of use, while femoral catheters are usually used for a single treatment (ambulatory patients) or for three to seven days in bed bound patients . However, the KDOQI guidelines suggest that non-cuffed, non-tunnelled catheters be used for less than one week and that cuffed, tunnelled catheters be placed for those who require dialysis for longer than one week . More recently a non-cuffed, non-tunnelled triple-lumen dialysis catheter has been developed. The purpose for third lumen is for blood drawing and the intravenous administration of drugs and fluid. In a multicenter, prospective study, blood flow rates and infectious complications were similar with double lumen catheter . Infectious complications are the principal reason why the catheter must be removed. Permanent Vascular Access Taking into consideration patient factors such as life expectancy, comorbidities, and status of the venous and arterial vascular system is very important in order to prescribe the appropriate access. Other factors are determined by the type of access itself, as arteriovenous fistula (AVF), arteriovenous graft (AVG), or TC which have a different effect on circulatory system. Also the duration of their functionality and the risk for infection and thrombosis are important factors to consider. Each type of surgical anastomosis has advantages and disadvantages . In 2002 the American Association for Vascular Surgery and the Society for Vascular Surgery published reporting standards according to which three essential components of VA should be mentioned: conduit (autogenous, prosthetic), location and configuration (strait, looped, direct, etc.) . Arteriovenous fistula An AVF is the preferred type of vascular access; it has the lowest complication rates for thrombosis (~ one-sixth of AVGs) and infection (~ one-tenth of AVGs) . There are 3 types of AVF s: à ¢Ã¢â€š ¬Ã‚ ¢ First type when artery and vein are connected in their natural position, either with a side-to-side or a side-artery-to-vein-end anastomosis. à ¢Ã¢â€š ¬Ã‚ ¢ Second type, where a vein is moved to connect to an artery in end-to-side fashion to either bridge a larger anatomical distance, or to bring the vein to the surface where it is accessible for cannulation and requires a tunnel to position the vein in its new location. à ¢Ã¢â€š ¬Ã‚ ¢ Third type where a vein is removed from its anatomical location and, is connected to an artery and vein in end-to-end fashion. Both second and third type requires the formation of a tunnel . End-to-end anastomoses are now rarely performed, since the complete disruption of the artery imposes a risk for peripheral ischemia and thrombosis. The most common surgical technique today is the side-to-end anastomosis. However technical problems as cutting the end of the vein in an oblique angle may create functional problems due to stenosis. An anastomosis more proximal in the arterial system should be smaller to prevent steal and limit maximal fistula flow, with the inherent complication of ischemic steal or heart failure . Arteriovenous fistula creation is often performed under local anaesthesia, with low morbidity and requires time for maturation. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate that AVFs should mature at least 14 days before use . Fistula size and flow increase over time, of 8-12 weeks and the initial blood flow rates has a range of 200-300 mL/min. Placement of AVFs should be initiated when the patient reaches CKD stage 4, or within 1 year of the anticipated start of dialysis. A physical examination should document blood pressure differences between the upper extremities and an Allen test should be performed, the lack of a well-developed palmar arch predicts a higher risk for vascular steal symptoms if the dominant artery is used for forearm fistulas creation due to inadequate collateral circulation . Ultrasound must be done before surgical implantation because it can provide information for maximal surgical success by mapping arteries and veins; eg, a preoperative arterial lumen diameter >2 mm is associated with successful fistula maturation, while a diameter of 600 mL/min, a diameter >0.6 cm with discernible margins, and be at a depth of 0.6 cm (between 0.5 and 1.0 cm) from the surface 6 weeks after creation. In fistulas that are maturing successfully, flow increases rapidly post-surgery, from baseline values of 30-50 mL/min to 200-800 mL/min within 1 week, generally reaching flows >480 mL/min at 8 weeks .The AVFs must be evaluated 4-6 weeks after placement, and experienced examiners (eg, dialysis nurses) can identify non-maturing fistulas with 80% accuracy . Arteriovenous graft AVGs were the most commonly used type of dialysis access in the US however, they do not last as long as AVFs and have higher rates of infection and thrombosis . Grafts present a second choice of VA when AVF are not able to be performed because of vascular problems. They can be placed in the forearm, the upper arm, and the thigh, and can have a straight, curved, or loop configuration. They may offer a large surface area for cannulation. AVGs can be cannulated about 2-3 weeks after placement, although there are studies suggesting that immediate assessment after placement for PTFE AVGs is possible . This interval is needed in order to allow the surrounding tissue to adhere to the PTFE conduit, to reduce the postsurgical oedema and the risk for local complications such as perigraft hematoma and seroma . Tunnelled hemodialysis catheter TCs are used when AVFs or AVGs arent possible to be created for several reasons such as multiple vascular surgeries, that lead to vascular thrombosis or when patients have severe peripheral vascular disease or very low cardiac output. Its more often in paediatric and very old patients. Unfortunately they are associated with the highest infection rate and they are not a very long-term access option. Studies have revealed that central venous catheters are colonized within 10 days of placement; however, colonization of the catheter biofilm does not correspond to positive blood cultures or clinical signs of bacteremia . Recently Power A. et al published their experience with 759 TCs. The survival rate at 1,2 and 5 years was 85%, 72% and 48% respectively. The infection rate was 0.34 per 1000 catheter day showing with careful and appropriate use of TCs, they can provide effective and adequate long term hemodialysis and rates of access related infection almost similar to AVGs . Hemodialysis vascular access in children The choice of replacement therapy in children is variable. The registry of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) reports that of patients initiating renal replacement therapy in paediatric centres : one quarter of children underwent preemptive renal transplantation, one half were started on peritoneal dialysis and one quarter were started on hemodialysis. Kidney transplantation remains the preferred therapy for paediatric patients therefore, many paediatric patients receive maintenance HD through an indwelling catheter in perspective of short HD period . In the United States less than 800 paediatric patients receive maintenance HD therapy, therefore surgical experience and clinical data for fistulae or grafts creation in small patients is limited due to rare need for such procedures. Smaller patients, especially those less than 10kg, are very demanding in surgical and nursing skill, this is significant reason the majority of smaller patients re ceive PD for their maintenance dialysis modality . Peritoneal dialysis is much more common in infants and younger children , significantly due to problems of vascular access. However, hemodialysis can be performed successfully in infants and very young children, as well . Children who will join in hemodialysis will need evaluation of their vasculature for placement of an arteriovenous (AV) fistula, arteriovenous graft, or cuffed double lumen catheter. The use of an AV fistula, the recommended type of vascular access in adults, is limited in children due to the size of their vessels. In the 2008 NAPRTCS annual report, vascular access for hemodialysis included external percutaneous catheter in 77.7 percent of patients, internal AV fistula in 12.3 percent, and internal and external AV shunt in 7.3 and 0.7 percent, respectively . K/DOQI has encouraged greater use of AV fistulas in larger children receiving hemodialysis who are not likely to receive a transplant within 12 months, with a goal of achieving more effective dialysis with fewer complications (eg, infection) than occurs with catheters. The choice of catheter size and configuration depends on the size of the patient. It is suggested by studies that in children as small as 4 to 5 kg a dual-lumen 8 Fr catheter can be well tolerated, and as the child becomes larger in size, a larger volume access can be placed . Vascular access should be able to provide sufficient blood flow and adequate dialysis with a Kt/V greater than 1.2. Kt/V is influenced further by the recirculation rate. Because flow rates in paediatrics vary by the size of catheter, which varies by the size of the patient, a recommended flow rate of 3 to 5 mL/kg/min is acceptable in most patients . Vascular access complications and Survival Studies have shown a mortality risk dependent on access type, with the highest risk associated with central venous dialysis catheters, followed by AVGs and then AVFs . The CHOICE study examined mortality based on access type in 616 hemodialysis patients for up to 3 years of follow-up. Central venous catheters and AVGs were associated with approximately 50% and 26% increased mortality, respectively, compared with AVFs with prevalence in men and elderly patients . Despite these findings and the KDOQI recommendations, dialysis access data from 2002-2003 showed that only 33% of prevalent hemodialysis patients in the US were being dialyzed via AVFs. Contrary in Europe and Canada, the majority of the patients (74% and 53% respectively) were being dialyzed via AVFs . Vascular access admissions continue to fall, with more procedures now performed in an outpatient setting, and are 45.1 percent below levels noted in 1993. By two-year time period, the adjusted relative risks of all- cause and cardiovascular hospitalization among hemodialysis patients vary little when compared to the reference period of 1997-1998; the risk of hospitalization for infection, however, is now 18 percent greater than in the reference period, while that of a vascular access hospitalization is 30 percent less. Among African American patients, the relative risk of an all-cause hospitalization or one related to infection is almost equal to that of white patients; the risk of a vascular access hospitalization, however, is 24 percent higher. In our previous work with 149 hemodialysis patients who had undergone 202 vascular access procedures (177 Cimino-Brescia fistulae and 25 PTFE grafts we found that the Cimino-Brescia fistula was used as the first choice of vascular access in all patients except one in the elderly group. PTFE grafts were the second or third choice in 7 patients younger than 65 and 15 in the elderly group (p: NS). The only reason for technique failure was vascular thrombosis in both groups (p: NS). Other complications were: aneurysms (10/48 and 14/101, p: NS), infections (0/48 and 2/101 p: NS) and oedema (0/48 and 6/101, p: NS). (Table à ¢Ã¢â€š ¬Ã‚ ¦.. Five-year technique survival of the first AV fistula in the two groups was 35% and 45% respectively (log-rank test, p: NS). (FIGUREà ¢Ã¢â€š ¬Ã‚ ¦..) Our findings suggested that there was no difference in vascular access complications across age groups and the survival of the first AV fistula is independent of age. Other encouraging results include a 22.9 percent fall in dialysis access admissions since 1999 for peritoneal dialysis patients, among hemodialysis patients, admissions for bacteremia/septicemia continue to rise sharply, reaching 112 per 1,000 patient years similar to the rate of 109 for vascular access infections, and possibly reflecting an increased use of cuffed catheters. In 2010 USRDS Annual Data Report hospitalization in 2008, increased again, to a point 45.8 percent above their 1993 level. In 2007-2008, women treated with hemodialysis were 16 percent more likely to be hospitalized, overall, than male. They also had a greater risk than men of cardiovascular, infectious, and vascular access hospitalizations 11, 14, and 29 percent greater, respectively. Recently unpublished our data are more different than those we published in 1998. We found in 189 patients that female had more possibility to start HD with double lumen catheter than male and also patients with heart failure ind ependent of sex. Female patients had PTEF grafts as first vascular access (p=0,023) and the elderly patients had more complications and more vascular access procedures (p=0.026). Non-tunnelled double lumen catheters complications The non-tunnelled double lumen catheters complications concern the insertion, the infection and thrombosis of the vessel. The severity and likelihood of insertion complications varies with the site of insertion. The complication rate and the severity are lowest in the femoral position. The primary problem is perforation of the femoral artery. Bleeding usually resolves within minutes of direct compression. Large femoral or retroperitoneal hematomas occur occasionally . Subclavian insertion complications are potentially more serious. Over-insertion of guide-wire can occasionally lead to atrial or ventricular arrhythmias. The vast majority of these are transient and hemodynamically insignificant . Penetration or cannulation of the subclavian artery can lead to hemothorax, which in some cases requires a thoracotomy tube. Cases of pericardial rupture and tamponade also have been described . Subclavian insertion from the left has an increased risk of atrial perforation which can present with acute hemopericardium upon initiation of dialysis. The incidence of pneumothorax varies from less than 1 percent to mor e than 10 percent of insertions, depending on the skill and experience of the physician. The risk of pneumothorax is greater from the left than right side, since the pleura and dome of the lung are higher on the left . Due to high rate of catheter-induced subclavian stenosis and subsequent loss of the ipsilateral arm for future hemodialysis access internal jugular vein insertion, particularly the right internal jugular vein is the preferred site of insertion. At internal jugular insertions carry a higher likelihood of carotid artery penetration, but a lower risk of pneumothorax (0.1 percent). Ultrasound guided cannulation of the vessel is recommended to minimize these complications. The location of the catheter tip in subclavian and internal jugular insertion should always be confirmed by fluoroscopy or x-ray prior to the initiation of hemodialysis or the administration of anticoagulants. Ultrasound-guided catheter insertion is lesser likelihood of arterial puncture or pneumothorax . Prevention and treatment of catheter thrombosis are important clinical issues. To prevent formation of thrombus, both lumens of the double lumen catheter are instilled with heparin following hemodialysis. The amount injected should only fill the catheter lumen to minimize systemic heparinization. Anecdotal evidence suggest that chronic anticoagulation with warfarin or low molecular weight heparin may also prevent catheter thrombus, due to either intraluminal clot or fibrin sheath formation . Lytic agents such as urokinase and alteplase are effective in treatment of catheter thrombosis. Alteplase has effectiveness rates in thrombosis treatment comparable to that observed with urokinase . However if non-cuffed catheters cannot have adequate blood flow then they should be exchanged. Ventral vein catheters are associated with the development of central vein stenosis . This complication appear s to occur more often with subclavian (40 to 50 percent of cases in some studies) than with internal jugular insertions (up to 10 percent) . It has been proposed that central venous cannulation creates a nidus of vascular injury and fibrosis. The rapid blood flows associated with the hemodialysis catheter then create turbulence that can accelerate endothelial proliferation, eventually leading to venous stenosis . The K/DOQI guidelines therefore recommend avoiding placement in the subclavian vein, unless no other options are available. If central venous thrombosis is detected early, it responds well to directly applied thrombolytic therapy or to percutaneous transluminal angioplasty when the fibrotic stenosis can be crossed with a guidewire . The infection risks associated with temporary double lumen catheters include local exit site infection and systemic bacteremia, both of which require prompt removal of the catheter and appropriate intravenous antibiotic therapy . Bacteremia gene rally results from either contamination of the catheter lumen or migration of bacteria from the skin through the entry site, down the hemodialysis catheter into the blood stream . Skin flora, Staphylococcus and Streptococcus species, are responsible for the majority of infections. There is conflicting evidence concerning the risk of infection based upon the site of insertion. In the largest prospective randomized study, the risk of infection was not reduced with jugular versus femoral venous catheterization . A prospective nonrandomized studies suggest that the infection risk appears to sequentially increase for hemodialysis catheters inserted into the subclavian, internal jugular, and femoral veins, respectively . Overall, compared with the subclavian vein, the internal jugular vein remains the preferred access site in ambulatory patients because of the high rate of central vein stenosis associated with subclavian vein catheterization (see above). In the Intensive Care Unit, either femoral or internal jugular vein placement is satisfactory, with the use of ultrasound making internal jugular vein placement safer. The best solution is to prevent the infection by proper placement technique, optimal exit site care and management of the catheter within the HD facility . Arteriovenous fistulas complications Complications of AVFs can be divided into early and late causes. Early causes include inflow problems such as small or atherosclerotic arteries, or juxta-anastomotic stenosis so a pre-operative evaluations for suitable access sites has to been performed . The aetiology of this acquired lesion is not entirely clear, but may be related to manipulating the free end of the vein, torsion, poor angulation, or loss of the vasa vasorum during anatomic dissection. This lesion often can be adequately treated with angioplasty or by surgical revision . Outflow problems may include accessory veins that divert blood flow from the intended superficial vessel to deeper conduits, or central venous stenosis in patients with prior central venous catheters. Vessels smaller than one-fourth of the fistula diameter are usually not hemodynamically relevant. Juxta-anastomotic stenosis and accessory veins are the most common causes for early failure AVFs when pre-operative evaluations for suitable access sites have been performed . Late causes for failure of AVFs include venous stenosis, thrombosis, and acquired arterial lesions such as aneurysms or stenosis. Venous stenosis may become apparent as flow decreases over time, worsening weekly Kt/V ([dialyzer clearance _ time]/body volume) or increasing recirculation. Native fistulas typically will not thrombose until flow is severely diminished. Static pressure measurements, which are helpful in graft monitoring, do not appear as helpful in AVFs, since collaterals surrounding the stenosis area often develop, effectively masking the rise in fistula outflow resistance. Stenotic lesions can be treated by angioplasty. Thrombectomy of fistulas, although technically more challenging than in AVGs, is often successful and if flow is re-established, primary patency is longer than in grafts . Aneurysms may form over the course of years as the fistula increases with increased flow and, unless associated with stenotic lesions, are more a cosmetic than functional concern. If the skin overlying the aneurysm is blanching or atrophic, or if there are signs of ulceration

Little Brother Music :: essays research papers

Little Brother: The Listening Describing this CD in three words would be personal, stylish, and free. Not â€Å"free† like it comes with your purchase of fifty dollars or more at Best Buy but â€Å"free† as in no boundaries or limitations. When I first put this album in my CD player and pressed play I was completely entranced by the sounds that followed. That was back in 2003 and still to this day you might catch me blasting songs in the morning or humming their tunes to sleep at night. If I try to put my finger on why this ONE album can last so long with a person as picky with music as me it would come down to how well the two rappers, Phonte and Big Pooh, convey every aspect of their lives into their lyrics. Not only can they describe fully the pressures of having a growing family and a low paying job, but also let loose stories about groupie love, haters getting put in their place, and partying until daybreak; all this with clever wordplay that puts them in a class of their own! I wouldn’t call them underground hip-hop because they don’t make a conscious effort to be different. They’re not considered mainstream because their focus isn’t just on making music to be rich. They’re just an alternative, and it is refreshing to hear someone strive to be the best at what they do artistically, not by how well they can market themselves. At a business level, we all know the importance the actual beat plays with finicky listeners. Even the songs with sub-par lyrics and rhyme schemes can still become a hit when a famous producer is behind the scenes. Luckily, production is another criteria Little Brother controls so well. Their producer, and third member of the group, is named 9th Wonder for more than just the cool moniker: he represents his own unique sound not yet overused and exploited by the masses. With a pension for taking old school samples and churning out beats unbelievably hypnotic and hard-hitting, 9th lays the backdrop perfectly for each a nd every bit of musical art on Little Brothers’ first major release. Taking a different direction than sampling producers like Kanye West and Just Blaze, he has been steadily gaining fame ever since he produced the song â€Å"Threats† on Jay-Z’s final record, â€Å"The Black Album†. Because