Taking a Look at Anorexia Nervosa - 1158 Words

Anorexia Sickness can quickly become a disease. An eating disorder called anorexia nervosa begins as a type of diet but turns into a disease that can severely affect many aspects of your life. This occurs when people reach the point of starvation because they are overly conscious of their weight, even though they may be dangerously underweight. When someone becomes obsessed with their self-image, action must be taken to provide the best treatment for them. Anorexia can become a serious problem that will change the way you think, act and feel. Because of various factors, individuals are devastated emotionally mentally by anorexia. One factor that triggers anorexia begins at an early age. Particular childhood events can lead to eating†¦show more content†¦In other cultures, eating disorders are just as ubiquitous. A study was done by Osvold Sodowsky, and it proved that Black and Native American women who were more accommodating with the American culture showed more symptoms o f anorexia than those who were less accepting of the white American way of living (Northwestern University). This proves that the impact from the media, especially in America, provides a hope for something that isn’t reachable. In past years, it was said that anorexia was most commonly found in upper-middle class White women, but over time, women of different ethnicities are also commonly confronted with anorexia. (Duckworth, Freedman). It is possible to lose enough weight to fit the standard that is set, but can hurt your life in so many different ways. Eating disorders are not just about food and weight; they affect someone both psychologically and emotionally. â€Å"Anorexics punish themselves for their perceived failures and self-hatred by restricting their food intake.† (Engel). Although this may be the case, people with anorexia don’t just take food from their lives, the fact that they have self-hatred to trigger it causes many more complications and long-term effects. Clearly, anorexia is not just a weight issue. Individuals mainly use food to control how they are feeling if they are placed in a conflict or feel insecure.Show MoreRelatedTaking a Look at Anorexia Nervosa1613 Words   |  7 Pagesthat I have learnt a lot about eating disorders and anorexia nervosa in particular. I researched the DSM V diagnostic criteria for anorexia nervosa. The criteria that must be met include an intense fear of gaining weight (even if the patient is severely underweight), restriction of calorie intake relative to requirements leading to a significantly low weight and an altered perception of one’s own body weight/shape. Sufferers of anorexia nervosa can be subdivided into two types: restricting (who cutRead MoreAnorexia Nervosa, Bulimia, And Binge Eating1694 Words   |  7 Pagesactivities, eating disorders are becoming more and more common. There are three main types: anorexia nervosa, bulimia, and binge eating. Binge eating is when you consume large amounts of food at one time, following the intake with no attempt to prevent weight gain. Bulimia is when you consume large amounts of food at one time, followed by an attempt to prevent weight gain, such as self-induced vomiting. Anorexia Nervosa is when you limit your food intake to little-to-none with the outcome of weight thatRead MoreThe Dangerous Effects of Eating Disorders1100 Words   |  5 Pagesthat you eat and how much you weigh, you often focus on little else (http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/def inition/con-20033575 ). There are three main types of eating disorders. Anorexia nervosa is the fear of gaining weight. If you have bulimia nervosa, you eat large amounts very quickly, and then you purge. Lastly, binge eating is where you feel out of control and you eat, and eat, and eat, and you cannot stop. Eating disorders can cause serious physical problemsRead MoreAnorexia Nervos Eating Disorders Association1013 Words   |  5 PagesIntroduction Anorexia nervosa is an eating disorder that affects about 0.5 to 1 percent of women in the United States today. (Anorexia Nervosa | National Eating Disorders Association) While, that may not seem like a lot of people are suffering from Anorexia nervosa it has received a significant amount of attention due to the consequences of developing this disorder. For example, it is reported that five to twenty percent of people who have Anorexia Nervosa will eventually succumb to theirRead MoreEating Disorders And Eating Disorder1410 Words   |  6 Pages as defined by our text book for class, is psychological disturbances that lead to certain physiological changes and serious health complications. The three most common and most easily identifiable forms of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. While most people who have eating disorders tend to be women from white middle-class upper-class families, eating disorders span social class, ge nder, race, and ethnic backgrounds (Floyd, Mimms, YeldingRead MoreEating Disorders Among Young Adults1015 Words   |  5 Pagessociety seeing famous people look like that it makes people take drastic measures to become skinny like them. Some people just don’t eat, others eat too much and then they make themselves throw up, and others don’t eat and then go exercise too much. Also we live in a society that is surrounded by food. In the United States there is a fast food restaurant on almost every corner and yet there is still an issue with eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating. When itRead MoreEating Disorders : Anorexia Nervosa998 Words   |  4 Pageseven social factors. Their main concern tends to focus on the amount of weight but yet gorge on varieties of unhealthy high calorie products (silverthorne1). In consequence females start to have Anorexia Nervosa or even Bulimia Nervosa. Even though both disorders are dangerous similarity Anorexia Nervosa and Bulimia have common symptoms on an individual’s health and can even lead to termination of their life. Initially both disorders can be caused by becoming obsessed with unhealthy foods such asRead MoreEating Disorders : Anorexia Nervosa1443 Words   |  6 Pageseating disorders can be characterized in three ways which include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa can be further broken down into two types which are anorexia nervosa restricting type, and anorexia nervosa binge/purge type. Eating disorders if approached early enough can be reversed with no damage or very minimal damage to the person. One characteristic of an eating disorder is anorexia nervosa. This characteristic as described by Hoeksema (2014) is seenRead MoreThe Risks And The Management Of Adolescents With Eating Disorders1218 Words   |  5 Pageswas supplied by the University of North Carolina at Chapel Hill School of Dentistry. The ultimate goal of this research was to educate dental professionals on anorexia nervosa and bulimia nervosa and how to identify the predisposing factors. To begin, Hicks and Roberts start off by start off by telling us that statistically speaking anorexia and bulimia are serious medical conditions that most commonly effect adolescents and young adults. In 2014, 70 million people worldwide showed clinical signsRead MoreEating Disorders and the Media941 Words   |  4 PagesAccording to the National Association of Anorexia Nervosa and Associated Disorders, â€Å"the body type portrayed in advertising as the ideals is possessed naturally by only 5% of American females.† (â€Å"ANAD†) Body image has been a controversial theme because of the influence of the media. It is a widely known fact that eating disorder cases are on the rise. The concept of body image is a subjective matter. The common phrase, â€Å"Beauty is in the eyes of the beholder,† holds true meaning in this sense. One’s

The Effects Of Medical Tourism - 1665 Words

Introduction Medical tourism is trending as time goes on and as the population increase throughout the world. Medical tourism is a concept where individuals from their native countries, visit foreign countries to receive the medical attention they need that is not available in their native country (CDC, 2016). This is further divided into outbound and inbound, inbound refers to the patients coming to the country and outbound refers to the individuals leaving the country (Horowitz et al, 2007). First world countries tend to hold most medical tourism out of all the other countries due to the perception of better medical care, but it comes at a very high cost, thus developing countries are building state of the art medical facilities to†¦show more content†¦With progressive upgrades in developing countries, medical tourism is becoming a viable option. Unorthodox locations for medical tourism such as Malaysia, Brazil, and India are becoming pioneers in state of the art medical treatments and equipment (Pashley H.S, 2012). For example, Turkey, India, and Singapore hold the most Joint Commission International Accredited hospitals in the world (Pashley H.S, 2012). Visiting developing countries is not only cost efficient, but treatment effective as well; individuals seek medical tourism due to ridiculous wait times and/or very expensive treatment. If an individual were to get a heart bypass surgery in the land of the free, it would cost 80% more than in any developing country($130,000), and a waiting period of 2-10 years depending on emergency (Hodges J.R et al, 2012). Hospital revenue and the economy are major aspects that hospitals and medical tourism operators have to consider and from the profit, India is seeing due to medical tourism is sought worthy; India has anticipated $2 billion industry in 2015 from inbound medical tourism alone (Henderson, 2014). Traveling to foreign countries can deem beneficial for those that are uninsured/underinsured and for those individua ls who are not in an urgent emergency or are placed on a long waiting period (Pashley H.S, 2012). In terms of Canadian Medical Tourism, individuals not only receive superiorShow MoreRelatedInternational Tourism s Effect On Medical Tourism1649 Words   |  7 PagesIntroduction In this paper, I will evaluate Hallyu in regards to its effect on medical tourism. However, I will first define the terms in order to give a clearer picture of what is Hallyu and which medical tourism I am referring too. Hallyu is defined as the growing popularity of Korean-based products that include drama, film, and pop music (Kim). It is also used to describe the fast spreading popularity of Korean culture like food, clothing, and housing. Recently, Hallyu or Korean Wave has notRead MoreThe Medical Tourism Industry Is Beneficial1728 Words   |  7 Pagescross cultural exchanges between guest (people coming for medical treatment) and host (country people are resorting to). To strengthen the argument as to why the medical tourism industry is beneficial is that it provides an opportunity to successfully promote the image of India as a healthcare destination as it forms customer relations with foreign travel companies as well as other global medical relatives (Singh, 2014, Pg.8). â€Å"Medical tourism can be considered a kind of import: instead of the productRead MoreThe Code Of Ethics And Advocate For Patients792 Words   |  4 PagesNursing Profession As patients continue to seek for medical tourism as their medical care options, nurses play a vital role in patient care and patient education. Under Provision 2 of the Code of Ethics, nurses are committed to provide patient-centered care and need to provide opportunities for the patients to participate in the patients’ care plans by working together with other health care providers (Fowler, 2015, p. 26). Nurses need to educate patients on health care environments of host countriesRead MoreMedical Tourism : An Open Gateway For Patients863 Words   |  4 PagesGenerally, medical tourism refers to the act of people travelling overseas to an under-developed country to obtain medical, cosmetic, or dental treatment. One main reason why medical tourism is becoming more popular is because not everybody has health insurance, and if they do have health insurance, the insurance company will most likely not cover the cost of the whole treatment, leaving patients in great debt. This is why people who cannot afford healthcare, choose to travel abroad as it is cheaperRead MorePublic Policy Paper Healthcare Vs Medical Tourism Essay1338 Words   |  6 PagesPublic Policy Paper Healthcare VS Medical Tourism Melodie Dominique Palm Beach Atlantic University GBUS 2813 01 American Free Enterprise Professor Tom Miller October 16, 2016 PUBLIC POLICY PAPER 2 America is portrayed throughout the globe as the land of opportunity and the home of the free. With all that the U.S. has to offer, it is unethical to see how the health care system has failed and is continuing to fail countless Americans. We constantly hear the stories of citizens who haveRead MoreMedical Tourism Essay1744 Words   |  7 PagesBackground Recently, there has been a large number of Americans flying to India for medical procedures. The practice of traveling abroad to receive both elective and non-elective medical procedures is called medical tourism (Steklof 722). The number of Americans who traveled overseas to receive medical treatment increased from 500,000 in 2005 to 750,000 in 2007 (Steklof 724). Many of these medical tourists are choosing to travel abroad due to rising healthcare costs and the difficulty to retrieveRead MoreThe Practice Of Travelling For Health And Medical Reasons1170 Words   |  5 PagesThe practice of travelling for health and medical reasons has a long history. Even the ancient civilizations recognized the therapeutic effects of mineral thermal springs and sacred temple baths. For example, the Sumerians constructed health complexes around hot springs more than four thousand years ago, which included temples with flowing pools. Ancient Romans built resorts with thermal health spas, and the rapeutic temples thrived during the Greek domain. Ancient Greeks were known for their travelsRead MoreImproving Health Care Workers : A Global Market That Allows Easier Access For Richer Countries991 Words   |  4 PagesBarriers associated with borders in a global market that allows easier access for richer countries to attract health care workers has a direct impact on the flow of health care (Packer, Labontà © Spitzer 2007, p. 21). Many countries are experiencing the effect of a shortage of trained physicians and nurses and have resulted in the use of foreign-trained health professionals to fill gaps (care (Packer, Labontà © Spitzer 2007, p. 15). Attempts have been made to continue the flow of health care workers asRead MoreMedical Tourism : The Global Commercial Organ Trade1495 Words   |  6 PagesMedical tourists usually choose to travel to other countries in order to receive health and dental care. Unfortunately because countries have differing approaches to address me dical tourism there is no set definition. However figures show that demand for medical tourism is on the increase . There has been wide debate if this facilitates exploitation, and if so how countries can combat this problem. Exploitation is most obvious in the global commercial organ trade. This is referred to as transplantRead MoreEffects Of The Civil War On Nepal1357 Words   |  6 PagesEffects of the Civil War on Nepal Nepal is considered one of the poorest countries in the world. It suffers in many aspects due to its immense state of poverty and political violence. The civil war in Nepal, stimulated by the Communist Party against the Nepalese State, stretched over the course of 10 years lasting from 1996 to 2006. This war, also known as the â€Å"Peoples War†, was launched because the Communist Party believed that there was an insufficiency in ensuring freedom, justice and welfare

Information Technology Ethics for Methodology-myassignmenthelp.com

Question: Discuss about theInformation Technology Ethics for Development Methodology. Answer: Introduction The paper focuses on implementing "Doing Ethics Techniques (DET)" for evaluating the ethical problems seen in Video 2 (Development Methodology) (Franck, 2017). In this paper proper evaluation is made to analyse the ethical issues related to ICT and implications will be accessed of the ethical problems. Also, in the last phase solutions that are ethical will be provided so that issues can be addressed and also ethical theories will be applied. Doing Ethics Technique Analysis What is going on? It is seen that a junior developer got a call from the customer. Customer requests to make some changes in the software. He told the client that the organization will make changes and give them the software before the given time. The junior developer confirms the request that the changes will be made without taking permission from the project manager. What are the facts? A junior developer of the organization receives a call from the customer related to change in the software. He failed to consult with the project manager regarding the changes and he confirms the changes requested by the client without the permission of project manager. This resulted in overridden of position hierarchy. What are the issues? The junior developer overrides the hierarchy by taking call of the customer directly. The junior developer gives confirmation to the customer that the organization will make changes to the software without taking advice from the project manager. The changes are made in the service contract by the junior developer who overrides the authority of the organization. Who is affected? Junior developer By receiving the call of the customer, the junior developer overrides the hierarchy which impacts the job position given to him in the organization. He also does not consider his responsibility and gave confirmation to the customer that the organization will make changes to the software and will deliver it within the deadline. The Customer The customer will be not satisfied and might face serious financial issues if the organization does not deliver the software with the changes within the given deadline. Project Manager A project manager has the responsibility to deal with the customers and give assurance of delivering software based on the request made by the customer. The changes that are confirmed by the junior developer can give an outcome in enhancing the issues for the project manager since he has to ensure that software is developed within the budget and it is delivered within the specified deadline. The Company If the confirmation made by the junior developer is not fulfilled by the given deadline then they might lose their contract in future and impact will also be seen on the image. The customer will be not satisfied and will impact the future contracts of the organization. What are the ethical issues and implications? In order to ensure ethical activities in the organization, it is important that employees follow a code of conduct and hierarchical authority can be maintained (Peters, 2015). The deontological ethics theory helps to judge the actions that are based on rules (Trevino Nelson, 2016). By taking into consideration this theory, it is seen that actions that actions of the junior developer were not correct (Zarim Zaki, 2016). The junior developer has given confirmation to the customers about the changes to the software without taking an advice from the project manager. He failed to fulfil his duties by overriding the hierarchy of position. The decision taken by the manager is ethically not correct. What can be done about it? There are various ways in which the project manager can manage the situation. It is important for him to realize the mistake so that this type of mistake cannot be done in future. He can identify the new changes that are required to be considered within time and resources given to the company or he should call a client and clarify the mistake done. In order to implement the changes, it is important that project manager take advice from project director. What options are there? A project manager should make some rules so that calls can be transferred to him and he can talk to the customer regarding the changes to ensure that they can complete the work without extending the deadline and budget. If project manager shouts on the developer then it can demotivate him towards the work and it can create a problem for the organization. A project manager should try to motivate the developer so that activities can be conducted smoothly. Which option is best and why? It is seen that best option is that project manager should make a request to the junior developer to make sure that this type of mistake does not take place in future. It will make him realize the organizational hierarchy and will limit the negative consequences that can take place in future. The changes should also be discussed with the project manager so that mistakes can take place in future (Al-Saggaf, 2016). Conclusion It is concluded that the action taken by the junior developer is not ethical. So to address this issue it is important that junior developer should realize the hierarchy so that mistake can be realized by the junior developer. Also, feedback should be given by the project manager to the junior developer so that this type of mistakes does not take place in future. References Al-Saggaf, Y. (2016, October 31).Scenario 2: Development Methodology.[Video File]. Retrieved fromhttps://www.youtube.com/watch?v=0npm9cEJBWY Franck, O. (2017). Varieties of conceptions of ethical competence and the search for strategies for assessment in ethics education: A critical analysis. InAssessment in Ethics Education(pp. 13-50). Springer, Cham. Peters, R. S. (2015).Ethics and Education (Routledge Revivals). Routledge. Trevino, L. K., Nelson, K. A. (2016).Managing business ethics: Straight talk about how to do it right. John Wiley Sons. Zarim, Z. A., Zaki, H. O. (2016). Ethics and Integrity in Building Employees Perceptions. Management,4(3), 131-137.

New Product Development Stew Leonards

Introduction Since its inception in 1969, Stew Leonard’s has positioned itself optimally in the United States’ grocery store industry by offering diverse food products. The firm has established four supermarkets, which are located in New York and Connecticut.Advertising We will write a custom essay sample on New Product Development: Stew Leonard’s specifically for you for only $16.05 $11/page Learn More The firm’s product portfolio is comprised of dairy products, meat, wine, and juice. In addition, the firm sells its products to over 300,000 customers every week. A workforce of over 2,000 employees necessitates the company’s operations. Stew Leonard’s has had exemplary performance over the past decades, as evidenced by its listing in the Guinness Book of World Records. This recognition was due to its sales per unit area in the category of all single food companies in the US. Despite its superior performance over the past four decades, Stew Leonard’s is experiencing pressure from the external market environment such as change in consumer behavior and intense competition. Thus, the firm’s top management team has an obligation to respond to the prevailing market trends. One of the most effective approaches that the firm should consider is new product development. This paper illustrates the critical aspects that Stew Leonard’s should consider in developing and introducing the new product. New product In line with its quest to offer diverse nutritional food products, it is essential for the firm to consider the introduction of a new snack product. The product should be produced from high-energy natural ingredients such as different whole grains, milk, and vegetables in order to meet the customers’ tastes and preferences. In order to improve the ability of the new product to provide customers with the needed energy within a short duration after consumption, it is imper ative for the firm to ensure that the snack product is easily digestible and absorbed by the body.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More In a bid to improve the snack’s capacity to provide the needed energy, the firm should incorporate some of the ingredients used in the production of energy drinks such as ephedrine, ginseng, ginkgo biloba, taurine, carnitine, inositol, and creatin. These ingredients will meet the customers’ energy requirements and enhance their well-being. Feasibility and profitability By introducing this product, Stew Leonard’s will greatly improve its performance. The feasibility and profitability potential of the new product is fostered by a number of factors. Food consumption Food consumption habits in the US were affected by the 2008 economic recession. Some market segments such as the private labels were least affected by the recession. During the recession, private labels’ prices varied between 20% and 40% as opposed to the branded equivalent. However, the trend has been reversed by the improvement in consumer confidence in the country’s economic performance over the past few years. A study conducted by the Business Monitor International (2014) records that per capita â€Å"food consumption is expected to rise by a compound annual growth rate of 2.6% between 2013 and 2018† (par. 5). Sustained economic performance will spur private consumption expenditure, which is critical in promoting profitability within the retail sector. Business Monitor International (2014) argues that private consumption expenditure is expected to grow by 2.2% between 2014 and 2018. By introducing the new product, Stew Leonard will be in a position to benefit from the improvement in the consumers’ purchasing power.Advertising We will write a custom essay sample on New Product Development: Stew Leonardâ€℠¢s specifically for you for only $16.05 $11/page Learn More Change in consumer lifestyle Consumers in the US appreciate the consumption of healthy food products. This trend has arisen from an increase in incidents of diseases associated with poor eating habits such as obesity. Currently, consumers are shifting to the consumption of healthy traditional snack foods. However, their preference mainly lies in the snack foods perceived to have high health benefits. The feasibility of the new snack product will be improved by the view that snacking has become a common trend amongst Americans. The NPD Group forecasts that snacking between main meals will increase by 5% to over 86.4 billion eating over the next five years (Prepared Foods, 2014). Product diversity By introducing the new snack product, the firm will enhance the attainment of the diversification strategy. Thus, Stew Leonard’s will be in a position to enter a new market segment, viz. the athletic market segment, which will be promoted by the unique product features. Competitive advantage Introducing the new product will improve Stew Leonard’s competitive advantage significantly. The competitive advantage will arise from the view that the firm expects the product to attract new customers due to the associated health, energy, and nutritional benefits. The health, energy, and nutritional benefits of the new snack will attract diverse customer categories. This aspect will lead to an increment in the firm’s sales revenue, hence its financial sustainability. Due to the attained level of financial sustainability, Stew Leonard’s will be in a position to finance diverse strategic aspects such as continuous product improvement, hence sustaining its competitive edge in the US food industry. Recommended mass media and social media channels After successful development of the product, it is imperative for Stew Leonard’s to create sufficient awareness on the ex istence of the new product in the market. Creating awareness is fundamental in an organization’s quest to improve the consumers’ purchase decision.Advertising Looking for essay on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More In a bid to create optimal market awareness, Stew Leonard’s should use the advertising technique, which entails mass media and social media channels. Mass media In its effort to create adequate market awareness through advertising, the firm should consider two main mass mediums, which include print media and broadcast media. The core broadcast mediums that the firm should integrate include radio and television. The firm should develop attractive advertising message in order to improve the likelihood of influencing the target customers. Moreover, the firm should create awareness using different print mediums such local newspapers, magazines, and brochures. In selecting the mass mediums, it is imperative for Stew Leonard’s to identify the most well established media houses in order to increase the likelihood of creating successful market awareness. Social media Market awareness should also incorporate social mediums. The core mediums that the firm should take into consid eration include Facebook, Google+, and YouTube. Justification The choice of the print and broadcast mediums will enable the firm to create optimal market awareness due to their capacity to reach a large number of potential customers in the US given their market penetration. Using television and radio will ensure that consumers in different regions receive the intended message simultaneously. Through these mediums, the firm will create awareness to the older customer group. Conversely, the choice of the three social mediums will enable the firm to reach the younger generation, which is increasingly becoming techno savvy. Furthermore, the two mediums have become critical sources of product information. Consequently, consumers are increasingly using the two mediums in searching information on different products. Moreover, social mediums are characterized by a multiplier effect due to the ‘word of mouth’ effect. Pricing structure In order to enhance its competitive advantag e through new product development, it is imperative for Stew Leonard’s to ensure that the product penetrates the market successfully. Price is one of the key determinants that the firm’s management team should consider in order to stimulate the rate of market penetration. The price structure adopted should influence the consumers’ purchase intention. The consumers’ purchasing decision is subject to the set price point. The firm should adopt the introduction pricing structure such as the penetration pricing strategy. This strategy will allow the new product to penetrate the market aggressively. The decision to adopt this pricing structure arises from the view that most customers already understand the benefits associated with healthy eating habits. Stew Leonard’s has developed sufficient economies of scale, hence its ability to set the price of the new product at a relatively lower point as compared to competitors. By adopting this strategy, the fir m will sacrifice short-run profits. However, Stew Leonard’s will develop an efficient market position, which will be a critical source of the firm’s competitive advantage. The strong market position will originate from the capacity to maximize the sales revenue due to the widespread market acceptance. Additionally, the penetration-pricing strategy will act as deterrence to potential competitors. Customer relationship management The high profitability potential in the US food industry has increased its attractiveness to investors. Furthermore, the existing firms are increasingly diversifying their product portfolio in an effort to exploit the market opportunities. Despite this trend, Stew Leonard’s can enhance the dominance of the new product by developing an effective customer-relationship management system. The CRM system should be aimed at entrenching product loyalty. One of the way through which the firm can achieve this goal entails integrating point of sale systems, which involves high-tech software that has the capacity to capture the customers’ details. Through this technology, the firm will be in a position to offer unique customer experience, for example, by designing loyalty programs. Symons (2014) affirms that on average, â€Å"13% of disgruntled consumers will tell at least 20 people about it† (par. 2). The automated POS will enable the firm to customize its service delivery by generating automated messages such as emails informing customers on different product aspects such as product improvement. Additionally, the POS will enable the firm to track the customers’ purchase history such as product inquiries. This aspect will improve the likelihood of influencing the consumers’ intention to purchase the product, for example, by designing attractive loyalty programs. Inherent risk Despite the fact that the introduction of the new product will present an opportunity for the firm to maximize its sales rev enue and profitability, it is imperative for the firm’s management team to appreciate the existence of inherent risk. One of the inherent risks that might affect the development of the new snack product entails change in consumer preferences. According to Ogawa and Piller (2006), consumers are characterized by heterogeneous product demands, which lead to micro-segmentation of product categories. Due to change in consumer tastes and preferences, it is difficult for the firm to undertake precise forecast on the sales revenue expected to be generated from the sale of the new product. The ultimate effect is that the commercialization of the new product will be affected adversely. This risk might arise if the firm does not have adequate understanding of the customers’ needs. Therefore, in a bid to minimize such risk, it is imperative for the firm to undertake continuous market research. The firm should use the findings of the market research to adjust its product developmen t plan. Risks of not launching The food industry is undergoing a remarkable transformation, which is arising from macro-environmental factors such as change in consumer behavior. In order to align with the changing market trends, it is imperative for firms to invest in extensive product innovation programs. The programs should focus on improving the firms’ market dominance through new product development. Failure to invest in new product development is a major risk that might affect the firms’ long run existence. The risk arises from the view that the ability of a firm to generate and sustain growth in sales revenue, hence its financial sustainability is hindered. The problem is further exacerbated by the view that the firm’s market dominance might be crowded-out by the competing entities. Therefore, the firm’s financial strength is diminished, which affects its prospected future growth. Conclusion The introduction of a new snack product will substantiall y improve Stew Leonard’s market dominance by attracting new customers. This goal will be attainable due to the unique product features. Product uniqueness will be enhanced through continuous market research, hence entrenching the customers’ tastes and preferences. This approach will remarkably minimize the inherent risk associated with its new product development. Furthermore, successful new product development will foster the firm’s longevity and market dominance in the US food industry. References Business Monitor International: United States food and drink report. (2014). Web. Ogawa, S., Piller, F. (2006). Reducing the risks of new product development. MIT  Sloan Management Review, 47(2), 65-70. Prepared Foods: Snack food consumption to increase. (2014). Web. Symons, G. (2014). Its all about customer experience: CRM systems and loyalty  programs. Web. This essay on New Product Development: Stew Leonard’s was written and submitted by user Marcus U. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Executive Orders Definition and Application

Executive Orders Definition and Application A presidential executive order (EO) is a directive issued to federal agencies, department heads, or other federal employees by the President of the United States under his statutory or constitutional powers. In many ways, presidential executive orders are similar to written orders, or instructions issued by the president of a corporation to its department heads or directors. Thirty days after being published in the Federal Register, executive orders take effect. While they do bypass the U.S. Congress and the standard legislative law making process, no part of an executive order may direct the agencies to conduct illegal or unconstitutional activities. Brief History or Executive Orders The first recognized executive order was issued by President George Washington on June 8, 1789, in the form of a letter to the heads of all federal departments instructing them to â€Å"impress me with a full, precise, and distinct general idea of the affairs of the United States.† Since then, all U.S. presidents, with the exception of William Henry Harrison have issued executive orders, ranging from presidents Adams, Madison and Monroe, who issued only one each, to President Franklin D. Roosevelt, who issued 3,522 executive orders. The practice of numbering and officially documenting executive orders as such did not begin until 1907 when the Department of State instituted the present-day numbering system. Applying the system retroactively, the agency designated the â€Å"Executive Order Establishing a Provisional Court in Louisiana,† issued by President Abraham Lincoln on October 20, 1862, as â€Å"United States Executive Order 1.† Perhaps the most impactful and certainly most famous executive order was the Emancipation Proclamation issued by President Abraham Lincoln on January 1, 1863, directing all agencies of the federal government to treat the 3.5 million African American slaves being held in the seceded Confederate states as free men and women.   Reasons for Issuing Executive Orders Presidents typically issue executive orders for one of these purposes:1. Operational management of the executive branch2. Operational management of federal agencies or officials3. To carry out statutory or constitutional presidential responsibilities Notable Executive Orders In 1970, President Richard Nixon used this executive order to establish a new federal agency, the National Oceanic and Atmospheric Administration, under the Department of Commerce.Shortly after the December 7, 1941, attack on Pearl Harbor, President Franklin D. Roosevelt issued Executive Order 9066, directing the internment of more than 120,000 Japanese-Americans, many of whom were U.S. citizens.In reaction to the terrorist attacks of September 11, 2001, President George W. Bush issued this executive order combining over 40 federal law enforcement agencies and creating the Cabinet-level Department of Homeland Security.As one of his first official actions, President Obama issued an executive order that some claimed allowed him to hide his personal records - like his birth certificate - from the public. In fact, the order had a very different goal. During his first 100 days in office, 45th President Donald Trump issued more executive orders than any other recent president. Many of President Trump’s early executive orders were intended to fulfill his campaign promises by undoing several policies of his predecessor President Obama. Among the most significant and controversial of these executive orders were: Executive Order Minimizing the Economic Burden of the Patient Protection and Affordable Care ActEO No. 13765 Signed: Jan. 20, 2017: The order reversed provisions of the Affordable Care Act - Obamacare - which he had promised to â€Å"repeal and replace† during the campaign.Enhancing Public Safety in the Interior of the United StatesEO No. 13768 Signed Jan. 25, 2017: The order, intended to reduce illegal immigration, denied federal grant money to so-called sanctuary cities.Protecting the Nation From Foreign Terrorist Entry Into the United StatesEO No. 13769 signed Jan. 27, 2017: The order temporarily suspended immigration from the Muslim-majority countries of Syria, Iran, Iraq, Libya, Sudan, Yemen, and Somalia Can Executive Orders be Overridden or Withdrawn? The president can amend or retract his or her own  executive order at any time. The president may also issue an executive order superseding or nullifying executive orders issued by former presidents. New incoming presidents may choose to retain the executive orders issued by their predecessors, replace them with new ones of their own, or revoke the old ones completely. In extreme cases, Congress may pass a law that alters an executive order, and they can be declared unconstitutional and vacated by the Supreme Court. Executive Orders vs. Proclamations Presidential proclamations differ from executive orders in that they are either ceremonial in nature or deal with issues of trade and may or may not carry legal effect. Executive orders have the legal effect of a law. Constitutional Authority for Executive Orders Article II, section 1 of the U.S. Constitution reads, in part, The executive power shall be vested in a president of the United States of America. And, Article II, section 3 asserts that  The President shall take care that the laws be faithfully executed... Since the Constitution does not specifically define executive power, critics of executive orders argue that these two passages do not imply constitutional authority. But, presidents of the United States since George Washington have argued that they do and have used them accordingly. Modern Use of Executive Orders Until World War I, executive orders were used for relatively minor, usually unnoticed acts of state. That trend changed drastically with the  passage of the War Powers Act of 1917. This act passed during WWI granted the president temporary powers to immediately enact laws regulating trade, economy, and other aspects of policy as they pertained to enemies of America. A key section of the War Powers act also contained language specifically excluding American citizens from its effects. The War Powers Act remained in effect and unchanged until 1933 when a freshly elected President Franklin D. Roosevelt found America in the panic stage of the Great Depression. The first thing FDR did was to convene a special session of Congress where he introduced a bill amending the War Powers Act to remove the clause excluding American citizens from being bound by its effects. This would allow the president to declare national emergencies and unilaterally enact laws to deal with them. This massive amendment was approved by both houses of Congress in less than 40 minutes without debate. Hours later, FDR officially declared the depression a national emergency and started issuing a string of executive orders that effectively created and implemented his famed New Deal policy. While some of FDRs actions were, perhaps, constitutionally questionable, history now acknowledges them as having helped to avert the peoples growing panic and starting our economy on its way to recovery. Presidential Directives and Memorandums Same as Executive Orders Occasionally, presidents issue orders to executive branch agencies through presidential directives or presidential memorandums, instead of executive orders. In January 2009, the U.S. Department of Justice issued a statement declaring presidential directives (memorandums) to have exactly the same effect as executive orders. A presidential directive has the same substantive legal effect as an executive order. It is the substance of the presidential action that is determinative, not the form of the document conveying that action, wrote acting U.S. Assistant Attorney General Randolph D. Moss. Both an executive order and a presidential directive remain effective upon a change in administration unless otherwise specified in the document, and both continue to be effective until subsequent presidential action is taken.

Writing College Papers Under Pressure How-Tos

Writing College Papers Under Pressure How-Tos Writing College Papers Under Pressure: How-To’s Any student knows how important it is to be able to properly manage time. With the ever-increasing amount of homework, academic assignments, projects, and other tasks routine for colleges and universities, 24 hours a day just isn’t enough for school and life. Besides, students aren’t robots, so huge workloads often lead to excessive stress. As a result, a typical student – a person most likely unable to manage stress (and even less likely to manage time) becomes a person with a chronic lack of time who’s constantly worried, disturbed, or stressed out. Therefore, to make students’ lives less stressful, we’ve prepared a short guide on the most popular time and stress management techniques. Using these techniques, you’ll be able to conquer your workload without straining your nervous system. So, first are the time management techniques: Use all kinds of lists and schedules. It might be a good idea to keep a record of things you need to do in separate lists, categorizing them by different criteria. For example, you could have lists titled â€Å"Things to do for biology class;† â€Å"To-do list for the next week;† â€Å"Most urgent stuff;† and so on. You can also estimate the approximate time needed to accomplish each of the tasks that you write down in these lists. Keep these lists where you can see them; this way you’ll never forget to do something important, and having them in front of your eyes all the time will help you allocate time more effectively. Don’t multitask. Focus your efforts! This may sound like unpopular advice, since the modern world values multitasking. However, it’s been proven that multitasking hinders performance. So, when starting to work on a task, you might want to focus all your efforts on it for a short period of time. Paraphrasing the famous saying: 80% of results are achieved during 20% of time spent working on a task. Eliminate distractions. It’s surprising how many things can actually distract us right at the moment when we need to focus on an important task. Students know that sometimes even cleaning up can be a huge distraction, especially when you need to prepare for an exam. So, make sure you block access to social networks for the time you’ll be studying (there are plenty of programs designed to do exactly that); turn your phone off; isolate yourself in a quiet room with no TV; and have only the needed textbooks and materials in your proximity. You’ll be astonished at how much time you have for actually studying when you eliminate all distractions! Maintaining a cheerful and healthy spirit is as important as being able to do everything on time. So, here are some relaxation and stress management techniques for you. Conscious breath. This is the basis of a huge number of meditation techniques, and for a good reason: breathing in such a way can significantly improve your overall psychological condition, help you relax and refresh. The technique is simple: you need to start breathing, paying full attention to the very process; feel how the air flows through your nose, how it fills your lungs. Notice a small pause between every inhale and exhale. It’s recommended that you breathe slowly, while being perfectly still. You must also do this exercise in silence. Physical exercises. It’s well-known that physical exercise after mental activity is a great way to relax. You don‘t necessarily need to go to a gym; instead, you can visit the nearest swimming pool. Swimming there for 45-50 minutes at least twice a week will positively affect not just your body, but your mind as well. Slowing down. Western society is fascinated with the idea that a person is worth something only when he/she is active, and has achieved something outstanding. This is the particular factor responsible for our crazy pace of life. Although it’s always good to accomplish something worthwhile, even more crucial is to maintain a balance between your mental health and your activities. At least once a week allow yourself to be slow. Don’t rush anywhere; don’t strain to do as much as you possibly can. You can afford being inactive. Take a slow walk in the park; ignore incoming messages, or at least do not reply them immediately; turn off your reminders and alarms; move slowly, think slowly. After a period of practicing this exercise, you’ll notice that you’ve become calmer. These are just some of the most popular techniques among hundreds of others. Feel free to find those that suit you the most, as there are no universal methods only those that work or don’t work personally for you. Good luck with writing! Additionally you may use professional custom writing service to buy college papers online.

Theatre comparison on 2 videos Essay Example | Topics and Well Written Essays - 1000 words

Theatre comparison on 2 videos - Essay Example In Arthur Miller’s Death of A Salesman, Willy, the main character, visits his boss, Howard, a man who happens to be the son of his prior boss. The scene radiates realism through the actors’ reaction of one another. It begins with Howard when he shows off his wire recorder: â€Å"Didn’t you ever see one of these? Wire recorder† and Willy asks, â€Å"Oh. Can we talk a minute?† but Howard ignores him: â€Å"Records things. Just got delivery yesterday. Been driving me crazy, the most terrific machine I ever saw in my life. I was up all night with it† (Miller.2.76). Howard is speaking animatedly. The pace of his delivery is quick and clipped as he is bursting with excitement, eager to explain every detail to Willy despite Willy’s need to talk to him about a business matter. In response, Willy’s tone is soft and submissive. When he supports the other actor, he is either ignored or shushed sternly like a child (Miller.2.77-78). The pac e and tone of each actor stems from a direct reaction to one another, thus implementing naturalism in the scene. Similarly in Blood Knot by Athol Fugard, Zachariah and Morris, half-brothers living together in South Africa, are brought to life through the actors’ interchange of dialogue through delivery. When they face each other discussing an imaginary woman in grey, their pace is prompt and heated. It sets up the notion that the characters are different from one another when Morris takes the lead on describing the imaginary scene in the park and Zachariah reacts without hesitation (Fugard.23:47-24:45). Zachariah supports Morris’s exhilarant play through a deep, monotone voice. This exchange on a verbal level creates realism because the scene is natural. Natural as defined by occurring in conformity with the ordinary course of nature: not marvelous or supernatural. Side-by-side, the plays incorporate the technique of tone and rhythm of delivery of text on different hei ghts. Howard’s swift pace of delivery exudes selfishness and pride. Later, it even displays boredom or disinterest when he addresses Willy: â€Å"But where am I going to put you, kid?...No, but it’s a business, kid, and everybody’s gotta pull his own weight† (Miller.2.80). However, Morris’s delivered exuberance shows impatient yearning, frustration and anger. He leans forward on the stage, directing his umbrella like an extension of his body then proceeds to stone the imaginary woman with pent up animation (Fugard.24:03-24:47). Immediately following, Morris beats his brother, making it a bizarre, but realistic twist because the previous dialogue set up the nature of the action through tone. There is similarity between the plays that transpire from delivery of speech. Willy and Zachariah are treated inferior by their counterparts, and they respond through dialect. Zachariah is â€Å"a black man who has endured prejudice and hate (â€Å"Blood Knot, † par. 3), but his brother fails to understand Zach’s struggle. During their role-playing, Zachariah commits to a slow pace that conveys eeriness. His tone is deliberately calm to show indifference, mirroring the state in which Morris treats him. There is no sympathy in the actor’s tone. Willy counteracts his opposer through rhythm and delivery as well. He pleads his case, but the desperation holds more weight during his lengthy speech (Miller.54:52-56:43) because the pace is crawling. The actor pauses throughout, which drives the point that Willy is a depressed, forlorn man at the end of his

Quantitative Analysis of Cinematic Statistics Research Paper

Quantitative Analysis of Cinematic Statistics - Research Paper Example Table 1, Appendices A shows total numerical values used for this analysis. The related trend between cinemas and screens as shown in Chart 1 Appendices A is that the number of screens increased over time in correlation with the number of cinema sites; however, as cinema sites tapered off, screens maintained a slight increase. The index number inferences, shown in Index A and B, Appendices A, describe a relative increase for screens of 5.5 percent in 2004 based on 1994, but only 0.3 percent for cinemas. Admissions revenue based on 1994 delivered a price relative average increase of 3.8%, and based on 1999 the price relative was only 2.8% as related in Index C, Appendices A. Furthermore, Chart 2 Appendices A describes the relative increase of admission revenue which can be correlated to the amount of screen increase per cinema. This infers that the more screens per cinema, the higher revenue increase. This is a good indicator for management staff that more revenue is generated the higher the concentration of screens, and for the customers this allows more mo vie options in a singular location, further increasing admissions revenue. Chart 3 Appendices A shows the sharp increase of admission revenue as cinemas increase, which induces the trend of a positive relationship. Using the linear regression equation y = 5.6951x - 3722.7, it can be derived that there is a trend of increase in admission revenue in relationship to cinemas sites. The correlation coefficient equals 0.877, which is a high value which infers a positive relationship between increase in admission revenue and cinema sites. The forecasted admission value for 2005 is 780.6082 m provided that 772 cinemas are built. Admissions and Cinema Screens Chart 4 Appendices A demonstrates a dramatic slope accession of admissions revenue as screens increase/ Linear equation Linear equation y = 7.3519x - 502.72 trends at a higher correlation between admission revenue and screens that noted in admissions and sites, the correlation coefficient with screens is 0.98486, intuitive of an impressive positive growth relationship between these factors. The forecast for admissions in relationship to screens in 2005 would be 25229.1m, provided that 3500 screens are built and the market can support that amount of cinematic screens, if 350 screens are built, the 2005 forecast would be 2070.45m, a more plausible plan of action. Gross Box Office (GBO) and Cinema Sites Chart 5 Appendices A plots the relationship between GBO and cinema sites, showing a sharp increase in GBO in relation to the increase in sites. The linear equation y = 0.0361x = 651.7 concludes to this positive relationship with a correlation coefficient of 0.892993 further demonstrates the solid positive increases in GBC as it relates to cinema sites. Forecasting for 2005 with 772 cinema sites-meaning that one cinema is inoperable-would bring a GBO of 3221.81 m, a slight decrease from 2004, but significant of the relationship between the number of cinemas and GBO. Gross Box Office (GBO) and Cinema Screens GBO and cinema screens also have a correlative relationship as visualised in Chart 5 Appendices A. This chart signifies powerful growth as the number of

Stereotypes of Culture Essay Example for Free

Stereotypes of Culture Essay This essay aims to explore benefits and disadvantages for managers to use sophisticated stereotypes. Stereotypes provide international managers an advantage of ‘first guess’ about cultural behaviors in countries and organizations so that they can develop appropriate strategies to cope with cross-cultural problems. However, it causes three drawbacks. If stereotyping is judging a group of people on the basis of theoretical concepts, it will be called ‘sophisticated stereotyping’ (Osland and Bird, 2000). The greatest benefit is sophisticated stereotype offers basic cultural knowledge, and is useful for managers to guess about cultural behavior in a country. Therefore, it is used as assistant tool in building unitary organizational cultures. The tourist firm relied on Hosftede’s framework. Because Japanese are collectivistic while Danish are individualistic, the Danish director had to consider whether provide guidance to Danish staffs or strict control to Japanese staffs, instead using individual competencies for all employees. Another example, the audio-visual firm took a chance of gender differentiation between Denmark and Japan to recruit suitable talents for their Tokyo office because it knows Japanese prefer masculine values. Hence it can say that sophisticated stereotypes can be a helpful weapon in implementing cultural management strategies. In contrast, sophisticated stereotypes cannot capture paradox which is the first disadvantage. In particular, if there are no exact cultures as described, people who depend on generalization studies cultural barriers will get confused. However, people who are acquired with cultural differences via their knowledge and experiences will be able to foresee what is most important and the best thing to do in foreign countries. Second, theoretical studies in national cultures are not sufficient to intercultural business context because international business embraced various cultures across borders. However, such scholars as Hofstede, Hampden-Turner and Trompenaars, Hall have studied in a single-national culture. Furthermore, sophisticated stereotypes do not describe potential cultural changes in intercultural encounters. These scholars had conducted researches for at least 19 years ago. Corporate cultures might change over time as a consequence of changes in perception and modern societies. In this case, national generalizations are useless to fit to intercultural encounters. Thus, managers merely gain insight into multi-cultural management by their experience and new approaches. In conclusion, because of above risks, sophisticated stereotypes merely are useful at the starting point for managers to guess cultural behaviors. Moving beyond sophisticated stereotypes, they need to make incremental changes by using their own knowledge to manage cultural issues.

On Distant View of a Minaret Essay -- essays research papers

In â€Å"Distant View of a Minaret† by Alifa Rifaat, a lonely wife describes life with her husband as â€Å"a world from which she had been excluded† (Rifaat, 1996, p. 256). While a woman paints a picture of a seemingly mundane afternoon, a minaret viewed in the distance provides the reader with vivid symbols of the underlying resignation of expectation and desire she once had for her marriage and her husband. The very first paragraph of the story describes the wife looking at her husband through â€Å"half-closed eyes† and being only â€Å"half-aware of the movements of his body† (Rifaat, 1996, p. 256). While it seems as if the wife is simply depicting waking up from sleep and noticing her husband, immediately upon reading the second paragraph the reader is made aware that the husband and wife are actually having sex. The immediate impression that the reader gets is that this woman is not only not having her needs met and has obviously resigned herself to this type of encounter with her husband by the offhand way she talks about noticing a spider’s web on the ceiling. The bleak tone of this story takes a particularly sad and disturbing tinge when the wife illustrates a scene from early on in her marriage where she tries to get her husband to satisfy her desire and provide her with mutual satisfaction, only to have him rebuke and reprimand her. In fact, the husband responds in such a particularly brusque and hysterical manner that the reader can see how traumatized the wife would have been at ...

Living in a dysfunctional family Essay

â€Å"I have learned that if one advances confidently in the direction of his dreams, and endeavors to live the life he has imagined, he will meet with a success unexpected in common hours†. These were the inspiring words of a famous writer and philosopher, Henry David Thoreau that has been etched in my heart as I have envisioned and prepared myself to follow the path that would lead me towards the achievement of my dreams. Living in a dysfunctional family and belonging to the minority are challenges that may either strengthen a person’s character or break a person’s life. Growing up without the full support and presence of my parents was not easy but these circumstances did not dampen my spirit. Instead, being in this situation has awakened my consciousness and I learned to be independent and responsible at an early age. Being the eldest among my siblings, I also became protective and nurturing and I managed to provide a balance between my studies and my responsibilities. At school, I developed a strong interest in subjects like Mathematics, English and History and I have engaged in various sports activities, e. g. soccer, basketball and hockey. Academics and sports have strengthened my mind, body and spirit and have taught me the importance of discipline, team work and camaraderie. In addition, my grandmother, whom I have lived with in the last few years, has instilled the value of obedience, hard work and integrity in my heart. These teachings and qualities will serve as my guiding principle in preparation for a career in law enforcement. Protecting lives and properties and preserving peace are part of my goals in life. I also want to make a difference in the lives of the youth who are lost and who find security in the company of those who violate the law. When I become a law enforcer, I would bridge the gap between my colleagues and the Hispanics and other immigrants so a relationship of trust will be built and strengthened. My entry in the university will not only allow me to interact with people with diverse cultural background. Most importantly, earning a degree in law enforcement will provide me with the skills and knowledge in reaching my dreams and in making a difference in the lives of the youth offenders.

Life Without Travel Is a Life Unlived

A Life Without Travel, is a Life Unlived ‘The world is a book and those who do not travel read only a page,’ said St Augustine. I’ve always had a love for travel, give me the resources and point me in a direction and I’m there. ? Just the other week, I had the opportunity to visit one of the largest cities in the world: Hong Kong. That opportunity came to me when I was on my way to work. I got phone call from a friend who just found out about a promo for Cebu Air Pacific for flights to Hong Kong. She asked me if I wanted in. Without any hesitation I said yes! Before even knowing when the dates are, I said yes.That was three months ago. I never had any regret for that decision . We left Baguio around midnight for the long trip to the Diosdado Macapagal Airport. We were excited, eager. We didn’t sleep the whole 4 and a half hour trip. Our flight was scheduled 9 am. We arrived 3 hours early. Yeah, were were excited. After that 3 hour wait and a two hour flight, touchdown Hong Kong! It’s funny that the travel from here to the airport was twice as long as compared to the time going to another country. After clearing customs and swooping our packs, the first thing we did was get something called an Octopus card.The octopus card is Hong Kong’s Universal way of paying for transportation fare. It’s very convenient. You just swipe your card and you can hop on anything. Buses, subways, ferries, trams, you name it. So with that we took a super efficient train right into the heart of Hong Kong. After a 30 minute ride and a few stops, We stepped off the air conditioned train and we were instantly awed by what we saw. There are thousands of people out on the streets shopping, eating and drinking and every street is lit up with electric signs and florescent lights with the classic Asian energy.Our first destination , even before dropping off our bags, was Ngong Ping village, the location of the Giant Buddha. The village is a culturally themed attraction with lots arts and music and you really get a feel for their traditions and culture. Visiting the Giant Buddha was the highlight of the experience that can only be reached by climbing up a 300 hundred step hill. The whole experience took the whole day. After that it was time to head into Hong Kong. The actual city of Hong Kong is built on a small island and for new development–the only place to go, is up.The entire city is covered with monster skyscrapers, huge hotels and super-malls. Transportation is super easy, everything is detailed in both Cantonese and English so it would be very hard to get lost. There’s plenty to see here: experiences of endless shopping, big-city nightlife and delicious dim sum are to be had. Visitors can find both colonial history and modern architecture. Its open society allows many different cultures to flourish and you would see a lot of nationalities there. You would not be surprised to see a lot of fellow kababayans walking around.The second day was spent in DisneyLand. Even though people say its one of the smaller Disneylands, I was still impressed. The first time I saw the Disney castle in the horizon I felt like a kid again. We got to ride all the rides, experience all the shows. It much better than I expected, lots to do there, it took up the whole day. The evening fireworks was unforgettable, with each explosion timed perfectly with the music. Everyone had their mouths open. I can say that, even if we’re grown up and all it still is a magical experience. The third day was for Ocean park.This was a fun filled day out and very good value for money! As well as the obvious scary rides. There was a ride there that when you were in strapped to the roller coaster the floor would disappear and have you ride around and around. Unforgettable. We were lucky enough to see the Pandas at feeding time and it was a wonderful experience to be so close to them. I loved the aquarium, where you can see and watch a whole eco system live in there, with thousands of fishes, sting rays, sharks and all kinds of sea life mingle with each other.With live dolphin shows, tons of stuff to see and do. I think this was my favorite place there. Day four was the day we had to go home. As we were leaving the skylines of Hong Kong, I cant shake of the feeling that it was all worth it. Between budgets and busy schedules, it is not always easy to set aside time and plan a getaway. But as Mark Twain has said, â€Å"Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do. So come out of your comfort zone. Explore. Dream. Discover. †

Karl Marxs Biography

Karl Marxs Biography Introduction Karl Marx was a great German philosopher who lived between 1818 and 1883. Philosophical ideas of Karl Marx revolve around economics, political, and social perspectives of the society. This analytical treatise attempts to explicitly review the philosophical ideas of Karl Marx.Advertising We will write a custom research paper sample on Karl Marx’s Biography specifically for you for only $16.05 $11/page Learn More Karl Marx’s biography Karl Marx was born in 1818 in the town of Prussian Rhineland. During his college education, Marx became an ardent follower of the thought of Young Hegelians which influenced most his works. His philosophy revolved around human society in the elements of class struggle and socialism. As a journalist, he worked for renowned papers such as the Cologne and the New York Tribune, where his columns attracted both criticism and praise in equal measure. Marx died in 1881. Philosophical ideas of Karl Mark Karl Ma rx expressed his sentiments on alienation and pain in the lower class workers imprisonment by the private individuals who have the resources to manipulate and twist social, development, and welfare aspects of the masses in the society. Specifically, the views of Karl Marx on the nature of class struggle, causes and responses to these struggles by the masses were drawn from France during the period of 1848 and 1850. In fact, Marx argued that these private individuals are drawn from the bourgeoisies and the ruling elites in the society. The bourgeoisies are thriving in discrimination and exploitation of labor supply to satisfy their selfishness. Since the bourgeoisies are the masters of labor production tools such as wages, this group, comprising of just a small percent of the society, comfortably sits at the apex of Maslow’s hierarchy of needs pyramid and cannot share the huge profits with the actual laborers who are subjected to harsh working conditions to create a surplus fo r their exploitative bosses (Shimp 17). As observed by Marx, the powerful private individuals influence labor laws processes in any country to suit their private needs which he termed as selfish.Advertising Looking for research paper on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More Marx described these laws as ‘only good’ when the same meet their opinionated threshold characterized by mere confirmation of their will; which may not necessarily be in line with the will of the underage employees subjected to inhuman work condition with very little and unreasonable pay. Karl Marx further pointed out that the agents of these masses such as labor unions are sometimes compromised to support the selfish course at the expense of the ordinary employees. Marx noted that the exploiters have formalized their definition partial policies in employee welfare and social interaction. The passionate appeals by the exploited proletariats who give ‘free labor’ are ignored by the bias labor policies and internalized corruption among the agents who should regulate these private individuals (Marx 21). Marx’s labor theory of value adopts a very simple approach to describe the type and source of profits in a production activity. Marx suggested that market equilibrium will be reached when market prices and production prices are equal as market competition will conspire to redistribute the excess value. This interaction will ensure that profit would be equalized by the competition. Marx acknowledged the dynamics of the labor market. In the ideal, the segmentation degree is controlled by union and government regulations that are designed to encourage rigidities and drive the costs of labor above the market clearing level. Therefore, the informal sector remains non proportional to reflect on the magnitude of the reforms required. When there is an assigned probability of selection within a spec ific period of time, then the probability of an ingression into formal employment should be a rising experience function in the labor ratios (Marx 11).Advertising We will write a custom research paper sample on Karl Marx’s Biography specifically for you for only $16.05 $11/page Learn More Marx was of the opinion that market equilibrium will be reached when market prices and production prices are equal as market competition will conspire to redistribute the excess value. Thus, increasing the function of production would eventually stabilize the profit rates in any long run production function. Though the approach adopted by Marx was very abstract, he succeeded in extrapolating the factors of product to different labor determinant ratios such as socially standard compulsory labor and the abstract labor to a homogeneous labor called the â€Å"multiple of unskilled labor† (Shimp 22). Karl Mark had bitter sentiments of alienation and pain in lower class imprisonment by the ruling class who have the resources to manipulate and twist social, religious, development, and political aspects of the society. Marx (1859) reflected in the actions of the political class in relation to the ordinary citizens. Marx identified selfishness, definition partial policies, and class systems as propagated by the political classes in capitalist societies (Marx 19). Marx concluded that political revolution is possible if the masses change their perception on labor provision and the laws that imprison them. As a result, he proposed a socialist approach through passionate appeal to the proletariats to rise above the normal way of life and start to question these bias policies and governance of labor which they provide for peanuts (Shimp 18). In a perfectly skewed labor market, Mark argued that wages are supposed to be determined by the cost of production and total output. Unfortunately, this is not the case. The masses are merely spectators of exploi tation as though our hands and minds are imprisoned in the dungeon of social classes. Noting that these bourgeoisies cannot operate and meet their selfish goals minus the labor from the masses, Mark proposed that these ordinary workers could unite and move from mere spectators into agents of quantifiable and desirable change they long to witness (Shimp 19).Advertising Looking for research paper on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More Conclusion Marx noted that the class struggles were influenced by the economic, social and political disparities between the bourgeoisies and the proletariats in the society. Marx concludes that the only solution to the class struggle is revolution to restore the socialism in the society. This is achievable when the ordinary workers unite and move from mere spectators into agents of quantifiable and desirable change they long to witness. Marx’s theoretical review of historical materialism is applicable in the modern society. The philosopher relates the political, social and religious systems of the past as a result of capitalism. The Marx notes that the building blocks of these systems are inequality, selfishness and vested interest. Apparently, these disparities have continued to promote class struggle in the modern society. The above views are applicable in the modern society because of the fact that development and perception of an individual are greatly influenced by even ts in his or her external environment such as the type of education received, religious doctrines, and the social media of interaction (Shimp 17). At present, these are skewed towards fulfilling selfish ambitions of the minority who are the ruling class in any society. Marx, Karl 1850, The class struggles in France, 1848-1850. PDF file. Web. Marx, Karl 1859, A contribution to the critique of political economy. PDF file. Web. Shimp, Kaleb 2009, The validity of Karl Marx’s theory of historical materialism. Web.

Definition and Examples of Associative Meaning

Definition and Examples of Associative Meaning In semantics, associative meaning refers to the particular qualities or characteristics beyond the denotative meaning that people commonly think of (correctly or incorrectly) in relation to a word or phrase. Also known as  expressive meaning and stylistic meaning. In Semantics: The Study of Meaning (1974), British linguist Geoffrey Leech introduced the term associative meaning to refer to the various types of meaning that are distinct from denotation (or conceptual meaning): connotative, thematic, social, effective, reflective, and collocative. See Examples and Observations below. Also, see: Conceptual MeaningConnotationFigurative MeaningGlittering GeneralitiesMeaningPolysemyReflected MeaningSemanticsSemantic TransparencyStipulative DefinitionSubtextSynonymy Examples and Observations A good example of a common noun with an almost universal associative meaning is nurse. Most people automatically associate nurse with woman. This unconscious association is so widespread that the term male nurse has had to be coined to counteract its effect.(Sndor Hervey and Ian Higgins, Thinking French Translation: A Course in Translation Method, 2nd ed. Routledge, 2002)Cultural and Personal AssociationsA word can sweep by your ear and by its very sound suggest hidden meanings, preconscious association. Listen to these words: blood, tranquil, democracy. You know what they mean literally but you have associations with those words that are cultural, as well as your own personal associations.(Rita Mae Brown, Starting From Scratch. Bantam, 1988)Pig[W]hen some people hear the word pig they think of a particularly dirty and unhygienic animal. These associations are largely mistaken, at least in comparison with most other farm animals (although their association with various cultural tradi tions and related emotional responses are real enough), so we would probably not include these properties in the connotations of the word. But the associative meaning of a word often has very powerful communicative and argumentative consequences, so it is important to mention this aspect of meaning.(Jerome E. Bickenbach and Jacqueline M. Davies, Good Reasons for Better Arguments: An Introduction to the Skills and Values of Critical Thinking. Broadview Press, 1998) Conceptual Meaning and Associative MeaningWe can . . . make a broad distinction between conceptual meaning and associative meaning. Conceptual meaning covers those basic, essential components of meaning that are conveyed by the literal use of a word. It is the type of meaning that dictionaries are designed to describe. Some of the basic components of a word like needle in English might include thin, sharp, steel instrument. These components would be part of the conceptual meaning of needle. However, different people might have different associations or connotations attached to a word like needle. They might associate it with pain, or illness, or blood, or drugs, or thread, or knitting, or hard to find (especially in a haystack), and these associations may differ from one person to the next. These types of associations are not treated as part of the words conceptual meaning. . . .Poets, songwriters, novelists, literary critics, advertisers, and lovers may all be interested in how word s can evoke certain aspects of associative meaning, but in linguistic semantics, were more concerned with trying to analyze conceptual meaning.(George Yule, The Study of Language, 4th ed. Cambridge University Press, 2010) The Lighter Side of Associative MeaningMichael Bluth: What do you think of when you hear the word, Sudden Valley?George Michael Bluth: Salad dressing, I think. But for some reason, I dont want to eat it.Michael Bluth: Right. But Paradise Gardens?George Michael Bluth: Yeah. Okay, I can see marinating a chicken in that.(Jason Bateman and Michael Cera in Switch Hitter. Arrested Development, 2005)

WHY IS CHINA AND THE COMMUNIST PARTY PRESENTIND THE HISTORY OF ZHENGS Essay

WHY IS CHINA AND THE COMMUNIST PARTY PRESENTIND THE HISTORY OF ZHENGS HE'S EXPEDITIONS POSITIVELY TODAY & DO YOU THINK CHINA CAN REPRSENT A ONE SIDED INTERPRETA - Essay Example There have been attempts to place Zheng He as predicting the emergence of China as a world power in the modern day. Several efforts by the Communist Party early suggest that it wants â€Å"to signal to its own people that it has recaptured past glory, while reassuring foreign countries that China can be strong and non-threatening at the same time.† (Kahn) However, the Chinese efforts to present a one sided interpretation of the explorer cannot be justified in this modern age of improved international cooperation among the world nations. It would be more advantageous for every nation to provide factual evidences to historical events and China, certainly, needs to present the objective facts in their attempt to make a better image of their fast. Historical facts and figures cannot be misinterpreted by any nation for its vested interest as there is no monopoly for any particular individual or nation over the truths of the past. The present criticisms by several intellectuals of the various parts of the world against the Chinese efforts to present a one sided interpretation of Zheng He indicates the same. In conclusion, while China has every right to have a pleasing image about its present and past, this cannot be at the cost of historical

Criminial justice assignment Example | Topics and Well Written Essays - 500 words

Criminial justice - Assignment Example When it comes to social disorganization theory, it dwells on the fact that people who live in slums do not follow the law especially because where they come from has social controls that do not work. This theory comes from works of people like McKay and Shaw who made a conclusion that divergent value marking areas that are not in order together with transitional populations bring about criminal activities. Strain theories on the other hand come because of people’s anger when they fail to accomplish the right economic and social success. Strain theories reveal that many people have similar beliefs and values however, whether or not they are able to achieve them depends on their social structure. One of the most renowned strain theories is that of Merton, which shows the consequences that, follow when people do not have enough resources in order to meet their own needs. Lastly in the social structure theories is the cultural deviance theory that brings out the fact that in low class areas there is an emergence of unique value system (Lantolf & Thorne, 2006). Reason being, in areas where people are of lower class they are taught to always be tough and go against authority. According to Ohlin and Cloward people in low class areas commit crimes because they believe they do not have the best channels to succeed in life. The conflict theory puts its emphasis on the political, social inequality of a social group. It makes people understand the power differences existing in society. It goes on to show how the dominant group, which is the people with power, controls those who do not have (minorities). Multiculturalism can be defined as the acceptance or promotion of many different ethnic cultures. This leads to people of diverse cultures accepting each other no matter how different they might be. Most of the cultural activities done by different cultures tend to step on women’s

All projects are expected to realise a certain Value Essay

All projects are expected to realise a certain Value - Essay Example Taking care of the elderly on an individual or family perspective can be a daunting task hence predisposing the elderly to lower quality of care. The LA project is therefore expected to generate value to the stakeholders such as the construction workers, the government, the families of the elderly, and the general population well-being in general. The family is one of the greatest beneficiaries that tap the benefit of having the elderly among them be taken care of. The challenge of caregiving among the elderly is demonstrated by the costs, energy, and the time taken with the elderly. These three important components can be used in other activities when there is a specialized care that is centralized by the LA. In essence, the elderly gets to have quality care while the family is less involved in the care. This means that they are able to tap insurmountable value from the establishment. The value in the family is also enhanced by the view that little effort is required in looking at the interest of the elderly among them. The LA home environment also adds value to the elderly by making them interact with others and hence have their view of life from the elderly perspective. The chances of the elderly being mistreated will be expected to be minimized since they are kept way from the family members and other caregivers that can easily mistreat them. In addition, the services that is provided in some home settings are poor or inadequate for the wellbeing of the elderly. This means that the elderly get to get quality care from the LA facility. The establishment of the LA project generates value to the constructors that tap a number of related benefits. Though indirectly related to caregiving for the elderly, the construction of the project will require contractors that will be paid in order to develop the project, these will further require suppliers and employees. All these stakeholders among

Radiation Protection for Angiography Procedure.

Radiation Protection for Angiography Procedure. Fluoroscopic procedure produces the greatest patient radiation exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure. a) Protection to Patient * A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on. * The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the user to the completion of the preset on time. This signal will remain on until the timing device is reset. * The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized. * Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding. * Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible. * Methods of limiting radiation exposure include: o making certain that the fluoroscopy unit is functioning properly through routine maintenance, o limiting fluoroscopic exposure time, o reducing fields of exposure through collimation, o keeping the X-ray source under the table by avoiding cross-table lateral visualization when possible, and o bringing the image intensifier down close to the patient b) Protection to personnel There are therefore three basic ways to minimize dose: * Reduce time of exposure * Use the inverse square law-doubling your distance away quarter your exposure * Use shielding by barrier These basics known as Cardinal Principle which is important to achieved ALARA. i) Time Radiation dose is directly proportional to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure. The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as follows: Exposure time = Exposure/Exposure rate Exposure = Exposure rate x time The algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small. Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure. ii) Distance The second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically as: where I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four. In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used. iii) Shielding Shielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible lead gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels. Shielding of occupational workers can be achieved by following methods: * Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical) * The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law). * Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields. Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary (scattered) radiation, not the primary beam. The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp. It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us. Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm. Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands; however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only. 2. State five clinical indications for the patient undergo the angiography procedure. 3. Explain the patient care management before, during and after the procedure Before a procedure: * Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure. * They must remove all jewelry before the procedure and change into a hospital gown. * If the arterial puncture is to be made in the armpit or groin area, shaving may be required. * A sedative may be administered to relax the patient for the procedure. * An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram. * Be aware of and follow all Local Rules and protocols * Prior to the angiography procedure, patients will be briefed on the details of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form. * Ensure that all exposures are justified and there is informed consent * Check patient identity * Position patient comfortably flat, with arm above head where possible * Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron * Check all staff are wearing radiation monitors correctly * Use all available lead shielding appropriately sited * Position table before screening * Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 – 90 kV is appropriate * Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient * Check all staff are as far away as possible in their role * Use dose reduction programmers when possible * Perform acquisitions on full inspiration where possible * Collimate closely to area of interest * Prolonged procedures: reduce dose to the irradiated skin eg. Change beam angulations * Minimize fluoroscopy time, high dose rate time and no of acquisitions * Remember software features, such as replay fluoro to minimize dose * Dont over use geometric magnification * Remove grid for small patients or when image intensifier / detector cannot be placed close to patient * Check and record screening time and DAP at the end of the case and review against the DRL. During the procedure: * The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter. * The radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. * When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities. * Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know. * Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels; this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV). After the procedure: * Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms. * If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released. * If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period. * The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for several weeks. * The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site. * Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately. * Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure. 4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure. * Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Â · Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique. 5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures. The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel. Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel. The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules. Technique Reduces Physician Radiation Exposure During Angiography Current technique requires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning. In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask; outside and inside the thyroid shield; on the right and left arm; outside and inside the lead apron; and on the right and left leg. The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques. Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia. Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients. It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram. New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this extension bar and lead plastic shield may be such a technique. Definition Angiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries. Purpose Angiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis; to diagnose heart disease; to evaluate kidney function and detect kidney cysts or tumors; to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain; and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neurosurgery. Precautions Patients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure. Description Angiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure. Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted. The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye. Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move. Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Because of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time. Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied. Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined below: Cerebral angiography Cerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete. Coronary angiography Coronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. Pulmonary angiography Pulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes. Kidney angiography Patients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour. Fluorescein angiography Fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour. Celiac and mesenteric angiography Celiac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied. Splenoportography A splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation. Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage. Aftercare Risks Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare. A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedures, and arrhythmias may develop. Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction. Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients. Normal results The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels. Abnormal results Abnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. Arteriosclerosis A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation. Carotid artery An artery located in the neck. Catheter A long, thin, flexible tube used in angiography to inject contrast material into the arteries. Cirrhosis A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension. Embolism A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal. Femoral artery An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography. Fluorescein dye An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography. Fluoroscopic screen A fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. Guide wire A wire that is inserted into an artery to guides a catheter to a certain location in the body. Iscehmia A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels. Necrosis Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. Plaque Fatty material that is deposited on the inside of the arterial wall. Portal hypertension A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach. Portal vein thrombosis The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension. For Your Information Books * Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed. Radiation Protection for Angiography Procedure. Radiation Protection for Angiography Procedure. Fluoroscopic procedure produces the greatest patient radiation exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure. a) Protection to Patient * A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on. * The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the user to the completion of the preset on time. This signal will remain on until the timing device is reset. * The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized. * Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding. * Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible. * Methods of limiting radiation exposure include: o making certain that the fluoroscopy unit is functioning properly through routine maintenance, o limiting fluoroscopic exposure time, o reducing fields of exposure through collimation, o keeping the X-ray source under the table by avoiding cross-table lateral visualization when possible, and o bringing the image intensifier down close to the patient b) Protection to personnel There are therefore three basic ways to minimize dose: * Reduce time of exposure * Use the inverse square law-doubling your distance away quarter your exposure * Use shielding by barrier These basics known as Cardinal Principle which is important to achieved ALARA. i) Time Radiation dose is directly proportional to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure. The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as follows: Exposure time = Exposure/Exposure rate Exposure = Exposure rate x time The algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small. Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure. ii) Distance The second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically as: where I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four. In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used. iii) Shielding Shielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible lead gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels. Shielding of occupational workers can be achieved by following methods: * Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical) * The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law). * Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields. Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary (scattered) radiation, not the primary beam. The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp. It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us. Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm. Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands; however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only. 2. State five clinical indications for the patient undergo the angiography procedure. 3. Explain the patient care management before, during and after the procedure Before a procedure: * Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure. * They must remove all jewelry before the procedure and change into a hospital gown. * If the arterial puncture is to be made in the armpit or groin area, shaving may be required. * A sedative may be administered to relax the patient for the procedure. * An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram. * Be aware of and follow all Local Rules and protocols * Prior to the angiography procedure, patients will be briefed on the details of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form. * Ensure that all exposures are justified and there is informed consent * Check patient identity * Position patient comfortably flat, with arm above head where possible * Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron * Check all staff are wearing radiation monitors correctly * Use all available lead shielding appropriately sited * Position table before screening * Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 – 90 kV is appropriate * Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient * Check all staff are as far away as possible in their role * Use dose reduction programmers when possible * Perform acquisitions on full inspiration where possible * Collimate closely to area of interest * Prolonged procedures: reduce dose to the irradiated skin eg. Change beam angulations * Minimize fluoroscopy time, high dose rate time and no of acquisitions * Remember software features, such as replay fluoro to minimize dose * Dont over use geometric magnification * Remove grid for small patients or when image intensifier / detector cannot be placed close to patient * Check and record screening time and DAP at the end of the case and review against the DRL. During the procedure: * The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter. * The radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. * When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities. * Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know. * Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels; this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV). After the procedure: * Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms. * If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released. * If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period. * The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for several weeks. * The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site. * Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately. * Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure. 4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure. * Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Â · Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique. 5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures. The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel. Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel. The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules. Technique Reduces Physician Radiation Exposure During Angiography Current technique requires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning. In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask; outside and inside the thyroid shield; on the right and left arm; outside and inside the lead apron; and on the right and left leg. The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques. Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia. Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients. It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram. New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this extension bar and lead plastic shield may be such a technique. Definition Angiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries. Purpose Angiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis; to diagnose heart disease; to evaluate kidney function and detect kidney cysts or tumors; to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain; and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neurosurgery. Precautions Patients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure. Description Angiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure. Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted. The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye. Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move. Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Because of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time. Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied. Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined below: Cerebral angiography Cerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete. Coronary angiography Coronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. Pulmonary angiography Pulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes. Kidney angiography Patients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour. Fluorescein angiography Fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour. Celiac and mesenteric angiography Celiac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied. Splenoportography A splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation. Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage. Aftercare Risks Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare. A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedures, and arrhythmias may develop. Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction. Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients. Normal results The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels. Abnormal results Abnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. Arteriosclerosis A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation. Carotid artery An artery located in the neck. Catheter A long, thin, flexible tube used in angiography to inject contrast material into the arteries. Cirrhosis A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension. Embolism A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal. Femoral artery An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography. Fluorescein dye An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography. Fluoroscopic screen A fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. Guide wire A wire that is inserted into an artery to guides a catheter to a certain location in the body. Iscehmia A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels. Necrosis Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. Plaque Fatty material that is deposited on the inside of the arterial wall. Portal hypertension A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach. Portal vein thrombosis The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension. For Your Information Books * Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed.