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.

Free Awakening Essays: A Reader Response :: Chopin Awakening Essays

A Reader Response to The Awakening  Ã‚   I had not read The Awakening before, and these notes are on a real â€Å"first reading† , and as a result deal mostly with my emotional response and thoughts on the style and general content of the story, I enjoyed the language and the â€Å"texture† of the writing. The subtle characterizations were done well, although the introduction of the characters seemed a bit unclear at times. The languid pace of the novel seem to fit the story and location of the action on one level, but seemed at odds with the violent, brash , turbulent nature of the emotional heart of the novel, Edna’s trying to connect to her true self. I often found myself wanting things to move on. At times the writing reminded me of Hemingway(of all people) in its description of eating and drinking , small actions that tell a lot about a character, and frequent use of French or Spanish phrases within the text: â€Å"Robert rolled a cigarette. He smoked cigarettes because he could not afford cigars,...† (44) â€Å"She was hungry again, for the Highcamp dinner, though of excellent quality, had lacked abundance. She rummaged in the larder and brought forth a slice of â€Å"Gruyere† and some crackers. She opened a bottle of beer...† (116) â€Å"Well, good-by, a jeudi,†...(108) â€Å"The sun was low in the west and the breeze was soft and warm.†(53) But unlike Hemingway, I often got the feeling that Chopin did not trust either her writing and the images and metaphors she used, or the reader to understand her more subtle sections. She seemed to feel often that she had to go back and tell the reader what a certain image or action â€Å"really† meant , as if we wouldn’t understand. It was difficult, especially at first, to identify with Edna. I thought at first that this woman just had too much time to think and little else to do with her life,(Which ultimately might be Chopin’s point). A woman with so little to really â€Å"worry about†, in the context that most of us have daily problems, mostly of a material kind, to take up our thoughts. Also. her reaction to her children,(as well as her husbands), made me feel for them.(This was the first thought that came into my mind when Edna walked into the ocean. Is finding freedom for our soul synonymous with freedom from our responsibilities?

Marriage and Happiness Essay

Humans are in search of two things: love and happiness. Whether it is from kids or significant others, people strive to reach feelings of connection in fear of being alone. In Gilbert’s, â€Å"Does Fatherhood Make You Happy? † and Crittenden’s, â€Å"About Love,† the authors question the roots of personal happiness. By comparing and contrasting Daniel Gilbert and Danielle Crittenden, it can be concluded that oneself does not solely determine happiness. The presence of children and significant others serve as major factors in emotional feelings of love and pride contributing to feelings of happiness. Gilbert’s, â€Å"Does Fatherhood Make You Happy† discusses how kids have an effect on a parent’s life along with their happiness. Starting his essay off by exchanging ideas in which children decrease the happiness of a parent by adding stress into their life, he ends with thoughts that kids make us happy nonetheless, since they are a product of two partners. For instance, Gilbert proclaims that the happiness children bring into a couple’s life may exhibit a small impact. In his words, â€Å"Children may not make us happy very often, but when they do that happiness is both transcendent and amnesic† (Gilbert 985). Children have the capabilities to make any individual happy. Gilbert’s point initially is that married couples start off blissful with each other, worrying only for themselves. Over time when the mates produce offspring, they progressively become unhappy, from when their kids are in diapers to when they hit adolescence. Research conducted by psychologists revealed that couples reach initial happiness when their kids grow up and move along with their lives. Gilbert refers to such a thought to show readers the truth of what really happens in parenthood. He states, â€Å"Our children give us many things, but an increase on our average daily happiness is probably not among them† (Gilbert 986). Parents withhold an unconditional love for their kids going beyond measures. Being patient and kind is in every parents’ nature to love and care for their children. A simple â€Å"I love you† can erase moments of despair. Crittenden’s â€Å"About Love† argues that people have been in search for autonomy, defined as the need to be oneself. Crittenden believes that in this newfound generation, humans are on a quest for independence yet they are also on a journey to find love. She also believes postponing â€Å"true feelings† such as trust, faith, and honesty can be like a prison (1010). If individuals are not able to display such emotions, they will trap themselves in their own prison. Crittenden’s point of view assumes that not being able to live for one person can be a negative and positive thing: â€Å"A woman will not understand what true dependency is until she is cradling her own infant in her arms†¦Ã¢â‚¬  (1009). She shows creating and maintaining a family helps women find their identity. She starts her essay off with views of being in search of autonomy, and ends with statements that women want the family aspect as well as children in life to complete them. Crittenden states: We all want the warm body next to us on the sofa in the evenings; we want the noise and embrace of family around us; we want at the end of our lives to look back and see that what we have done amounts to more than a pile of pay stubs, that we have love and been loved, and brought into this world life that will outlast us (1008). To love and be loved amounts to more than just fulfilling another lone soul, helping humans create lives and opportunities of happiness. People are often too fearful of taking responsibility of not only themselves, but of others. In Crittenden’s words, â€Å"Too often, autonomy is merely the excuse of someone who is so fearful, so weak that he or she can’t bear to take on any of the responsibilities that used to be shoulder by much younger but more robust and mature souls† (1008). Fear of commitment, and bearing others serves as a block in the road to find happiness. Gilbert and Crittenden both assert in one way or another that individuals attempt to find a source of happiness by raising a family, or taking responsibilities from others. On one hand, Gilbert overlooks what I consider an important argument about the happiness a kid brings. Objecting with his proposals, I argue against Gilbert, as children do indeed stimulate joy. Believing that the impact of happiness kids deliver is rare and trifling is ludicrous. How could you ever disagree with what makes an individual happy? Happiness is within the eye of the beholder. It becomes apparent that kids make their parents smile, laugh, and show emotions no one else can achieve. My thoughts come to more common ground with Crittenden as she argues that letting go the fear we hold and opening our hearts to love would help individuals reach a sense of happiness. I strongly agree with this argument because we won’t fully understand what happiness can truly reveal until we can make others beside ourselves happy. Having someone to share goals, dreams, and aspirations with creates a new bond. Being able to witness another person be proud of what you accomplished can help you acquire personal happiness. I wholeheartedly endorse what Crittenden refers to as strengthening a muscle by using it (1009). We train our muscles such as our heart to be strong. If we are not able to put our heart into use, we will never know how to express feelings of love and merriment to others. Growing up, getting married, and having children is what most women envision in the future. The risk of commitment and willingness to be open is scary, but it’s a risk worth investing in. Many people argue that looking for love is only a petty excuse to get away from loneliness. They assert that relationships only create madness, kids are a waste of time, and families make you lose sanity. However, if one were to argue against my beliefs I would assure them finding a partner is not as daunting as it sounds. Along with kids are put on this earth for a reason: to bring joy. Finally that family is always there for love and support. Love finds a wonderful place in this world to make humans experience acceptance. As Crittenden would point out, â€Å"the moment we say, ‘I Do,’ we have answered one of the great, crucial questions of our lives: We now know with whom we’ll be spending the rest of our years†¦Ã¢â‚¬  (1009). Content with the emotional connections, the commitment of love opens a whole new spectrum of happiness. Although many individuals argue that being alone is far off better, having someone to love and care for is a beautiful experience. My discussion of love and happiness is in fact addressing the larger matter of what really is happiness. Assuming the bigger picture, one will define personal happiness as surrounding themselves with a big family with a husband and five kids. Another may define bliss as merely two soul mates being together forever. Many others will define joy as autonomy and coming home to a lone household. These conclusions have significant applications on Gilbert’s idea of a couple being satisfied without kids, as well as Crittenden’s point of considering someone to love and be open to. Humans are able and willing to find their own personal happiness. To love and be loved is one of life’s greatest aspects to being able to complete an individual. Works Cited Crittenden, Danielle. â€Å"About Love. † What Our Mothers Didn’t Tell Us: Why Happiness Eludes the Modern Woman. New York: Simon & Schuster, 1999. 1008-010. Print. Gilbert, Daniel. â€Å"Does Fatherhood Make You Happy? † Stumbling On Happiness. N. p. : HarperCollins, 2006. 984-86. Print.

Managing Operational Activities to Achieve Business Results

London School of Science & Technology ASSESSMENT COVER SHEET – RESIT Unit Number and Title Assessment Title Course Title Assessment Code Hand Out Date Unit 15: Managing Business Activities to Achieve Results Managing Operational Activities to Achieve Business Results HND Business HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 01st March 2013 Hand In Date 11th May 2013 Lecturer(s) Anup Bista Adrian Gauci Dhaneswar Chooramun Internal Verifier Jonathan Cartmell Course Notes / Slides / Activities / Handouts. 1.Recommended Learning Textbooks: BPP (2010) Management: Communication and Achieving Results – Business essentials – supporting HNC/HND and foundation degrees, BPP Learning Media: London Slack N. , (2007) Operations Management, 5th Edition, Financial Times: Prentice Hall Watson, G. and Gallagher, K (2005) Managing For Results, London: CIPD. 2. Recommended BMW Documentaries on Business Activities: CNBC Documentary – BMW Quality Processes http://www. youtube. com/wat ch? v=OPSCh3Ys_B8 National Geographic – Megafactories Doc BMW / Mini Quality http://www. outube. com/watch? v=kk98q1N4XXI 3. Recommended Learning Weblinks: www. bsieducation. org (British Standards Institution) http://www. bmwgroup. com (BMW Education) http://www. wincanton. co. uk (Supply Chain Management) www. times100. co. uk (Times Resources) http://www. quality-foundation. co. uk(UK Quality Foundation) http://www. efqm. org/ (EU Foundation Quality Management ) Sources of information To be filled by the student Student Name Student ID Lecturer Group(e. g. ) HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 1|Page London School of Science & TechnologyAssessment Requirements †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ An electronic copy of your assessment must be fully uploaded by the deadline date and time. You must submit one single PDF or MS Office Word document. Any relevant images or screenshots must be included within the same M S Office Word or PDF document. The last version you upload will be the one that is marked. The file size must not exceed 20MB. Answer the criteria in order, clearly indicating the CRITERIA number. Ensure that all work has been proof-read and checked prior to submission.Ensure that the layout of your documents are in a professional format with font style Arial, font size 12 for the text, font 14 for sub heading and font 16 for main heading, line spacing 1. 5 and justified. Use the Harvard referencing system and provide references [e. g. (Smith, 2011)] within the text and an entry in a references list. Otherwise it will be considered as plagiarised work. Ensure that you back-up your work regularly and apply version control to your documents. Ensure that any file you upload is virus-free, not corrupted and not protected by a password otherwise they will be treated as a non-submission.You must NOT submit a paper copy or email of this assessment to any member of staff at LSST. Your work must be original with the appropriate referencing HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 2|Page London School of Science & Technology WHAT TO DO: You are required to read the following scenario and attempt all tasks given in the table below by relating your response to the context of the given organisation in the scenario. CASE STUDY Imagine you are the Operations Manager at the BMW Headquarters in Munich.You have been asked by the Board of Directors to review the below business activities to improve the operations, quality and efficiency of a BMW manufacturing plant in the UK. Your review will be used by the Board of Directors to improve the operational activities such as BMW’s business functions, processes and quality standards to achieve better results in 2014. The review should be structured to cover areas of: TASK 1 – Business processes in delivering outcomes based upon business goals and objectives. TASK 2 – Plans for own areas of responsibility for managin g business activities.TASK 3 – Monitoring appropriate systems to improve organisational performance. TASK 4 – Managing health and safety in the workplace. Due to the continuous changing nature and complexity of managing business activities within an organisation, you are required to research, gather and present the appropriate information. This will include the use of management theories and practical examples applicable to BMW company. You are to present your responses in a detailed report format to fulfill each Pass Criteria with appropriate Harvard Referencing technique for the tasks below.Additional Information/Advice: A support textbook is also available for this Unit, which you may find helpful to explore theoretical knowledge and understanding. You may also access the following links to carry out your further research to support your responses with some practical examples in the context of BMW company. YouTube – Official International BMW Channel http://w ww. youtube. com/user/BMW CNBC Documentary – BMW Quality Processes http://www. youtube. com/watch? v=OPSCh3Ys_B8 National Geographic – BMW – Megafactories Series Documentary http://www. youtube. com/watch? =kk98q1N4XXI HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 3|Page London School of Science & Technology PART A – PASS CRITERIA ONLY Pass In order to achieve Pass, students must achieve all the pass criteria below. TASK 1: Business processes in delivering outcomes based upon business goals and objectives. PASS CRITERIA 1. 1 (Approx. 150 words) Recommended interim deadline 9th March Describe briefly the importance of two core organisational functions and evaluate the interrelationship between these functions in managing business activities to achieve results in a company like BMW.Guidelines: In order to complete the above task, your answer should: †¢ Include a definition of what operations management is as a function. Identify the two most important function s for business operations at BMW. †¢ Establish the interrelationship between at least two chosen functions above and evaluate how each function operates, interacts and supports to each other in operation. †¢ Bear in mind, your response should relate to the given company BMW in the scenario. In answering this question, you will have covered the following assessment criterion: †¢ 1. Evaluate the interrelationship between the different processes and functions of the organisation. PASS CRITERIA 1. 2 (Approx. 150 words) Recommended interim deadline 15th March Explain the adopted economic system approach (i. e. input – output model) including transformation process within BMW and evaluate the effectiveness of the used forms of transformation process to achieve operational objectives. Guidelines: In order to complete the above task, your answer should: †¢ Provide evidence to demonstrate the adopted system approach such as input, output and method of transformatio n.Expand your thoughts into â€Å"the transformation process† of operations management including at least one example for each material, customer and information processing operations. †¢ Describe the effectiveness of the used forms of transformation processes to the context of the operation to map processes for achieving operational objectives. †¢ Bear in mind, your response should relate to the given company BMW in the scenario. In answering this question, you will have covered the following assessment criterion: 1. 2 Justify the methodology to be used to map processes to the organisation’s goals and objectives.PASS CRITERIA 1. 3 (Approx. 150 words) Recommended interim deadline 24th March Describe the role of quality gateways in mapping operational processes and evaluate how processes can be designed in order to achieve targeted output, using BMW as an example. Guidelines In order to complete the above task, your answer should: †¢ Include the meaning o f quality gateways and discuss its role in transformation process. †¢ Include the content of a ‘process map model’ in your response if required. HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 4|Page London School of Science & Technology †¢ Evaluate how quality gateways will help to map the operational processes in order to achieve targeted output. Relate to the given company BMW in the scenario. In answering this question, you will have covered the following assessment criterion: 1. 3 Evaluate the output of the process and the quality gateways. TASK 2: Plans for own areas of responsibility for managing business activities. PASS CRITERIA 2. 1-2 (Approx. 150 words) Recommended interim deadline 11th April Briefly explain what you understand by setting up ‘SMART Objectives'. Write two SMART objectives that BMW should embrace to improve quality.Create one operational plan with five stages for one of the above SMART objectives by applying MBO or Planning Hierarchy and Planning Process Models. Guidelines In order to complete the above task, your answer should: †¢ Include at least two SMART objectives for BMW and explain why they are SMART. †¢ Review the concept of MBO again in setting your smart objectives to align people and other resources in an efficient and effective way. †¢ Your plan should promote collective goals and objectives by applying MBO or Planning Hierarchy and Planning Process Models.In answering this question, you will have covered the following assessment criterion: 2. 1 Design plans which promote goals and objectives for own area of responsibility. 2. 2 Write objectives, which are specific, measurable, achievable, realistic and time-based to align people and other resources in an effective and efficient way. PASS CRITERIA 2. 3 (Approx. 150 words) Recommended interim deadline 20th April Identify two appropriate systems and explain how they can be implemented effectively in order to achieve the set SMART objectives by meeting organisational standard of quality.Guidelines In order to complete the above task, your answer should: †¢ Include systems such as ‘accounting/finance system’, ‘management information system’, EDI, ERP, SCM, CRM, the quality system’, ‘CPA (Critical Path Analysis) and PERT (Project Evaluation & Review Techniques) etc. †¢ Consider at least two appropriate systems given above and explain their effectiveness to achieve the set objectives in most efficient way. †¢ Relate to the given company BMW in the scenario. In answering this question, you will have covered the following assessment criterion: 2. Implement appropriate systems to achieve objectives in the most efficient way, on time, to budget and meeting organisational standards of quality. HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 5|Page London School of Science & Technology PASS CRITERIA 2. 4 (Approx. 150 words) Recommended interim deadline 23rd April Identify the Project P lanning model/tools and discuss how you utilise one of these techniques either (i) Project Evaluation & Review Techniques (PERT) or (ii) Critical Path Analysis (CPA) to monitor and control the entire project operation.Guidelines In order to complete the above task, your answer should: †¢ Include the aim of the project planning for managers and discuss the tools involved in project planning process applicable to BMW. †¢ Expand the response with brief explanation on how the planning tools such as Project Evaluation & Review Techniques (PERT) and Critical Path Analysis (CPA) can be used to monitor and control the entire project operation. †¢ Use a diagram for planning tools if necessary.In answering this question, you will have covered the following assessment criterion : 2. 4 Carry out work activities meeting the operational plan through effective monitoring and control. TASK 3: Monitoring appropriate systems to improve organisational performance. PASS CRITERIA 3. 1 (Ap prox. 150 words) Recommended interim deadline 29th April Explain what you understand by the concept of quality and analyse the implemented quality system in managing and monitoring quality standards within BMW.Guidelines In order to complete the above task, your answer should: †¢ Include a definition of quality and the role of quality concept to BMW. It is essential to recognise the various Quality Management System (QMS) such as Quality Circle, ISO 9000/EN29000 standards, Costs of Quality etc and assess the implication of these systems to the context of BMW. Pick two Quality Control systems at BMW as examples. In answering this question, you will have covered the following assessment criterion: 3. Design systems to manage and monitor quality standards specified by the organisation. PASS CRITERIA 3. 2-4 (Approx. 350 words) Recommended interim deadline 1st May Define the Total Quality Management (TQM) philosophy and explain how this philosophy can be used to increase quality and efficiency, and to reduce costs by creating a quality culture of improvement within BMW. Identify at least three required changes or improvements that you would suggest on the BMW quality system with your justification in order to create a sustainable quality culture for continuous improvement.Guidelines In order to complete the above task, your answer should: †¢ Explain the theory of TQM on how it helps to create a quality culture to ensure continuous monitoring, evaluation and development of the process within BMW. †¢ Support your view with some examples from BMW. †¢ Include reference to Business Process Re-engineering for the three required changes. In answering this question, you will have covered the following assessment criteria: HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 6|Page London School of Science & Technology 3. Demonstrate a quality culture to ensure continuous monitoring, evaluation and development of the process. 3. 3 Recommend improvements which align wit h the organisation’s objectives / goals resulting in improvements. 3. 4 Report on the wider implications of proposed changes within the organisation. TASK 4: Managing health and safety in the workplace PASS CRITERIA 4. 1-2 (Approx. 200 words) Recommended interim deadline 10th May Investigate how three different Health and Safety Acts and Regulations have been implemented within BMW and explain why BMW needs to carry out risk assessment as required by the legislation.Guidelines In order to complete this task, your answer should: †¢ Show awareness and impact of relevant legislative requirements for the BMW. †¢ Identify relevant three legislative regulations and explain the impact of these on health and safety procedures within BMW. †¢ Consider how a risk assessment could be carried out and its impact on the organisation. In answering this question, you will have covered the following assessment criteria: 4. 1 Carry out risk assessments as required by legislation, regulation and organisational requirements ensuring appropriate action is taken. 4. Demonstrate that health and safety regulations and legislation applicable in specific work situations are correctly and effectively applied. PASS CRITERIA 4. 3-4 (Approx. 200 words) Recommended interim deadline 10th May Explain a procedure to identify hazards and risks in the organisation and discuss how this should be managed. Guidelines In order to complete this task, your answer should: †¢ Include a procedure to identify and assess hazards and risks in BMW, and show how this would be managed. †¢ Demonstrate that you can distinguish between a hazard [i. e. potential of harm] and a risk [i. . likelihood of harm caused by the hazard] within BMW. †¢ Support your response by producing two examples of hazards and risks at assembly line of BMW manufacturing plant in the UK. In answering this question, you will have covered the following assessment criteria: 4. 3 Carry out a systematic rev iew of organisational health and safety policies and procedures in order to ensure they are effective and compliant. 4. 4 Carry out practical application of health and safety policies and procedures in the workplace. – THE END – HND Bus-Unit 15/ MBAAR Feb 2013 RESIT 7|Page

Liberace Biography and Profile

Liberace Biography and Profile Wladziu Valentino Liberace ( May 16, 1919 - February 4, 1987 ) was a child piano prodigy who became a star of live concerts, television, and recordings. At the height of his success, he was considered one of the worlds highest-paid entertainers. His flamboyant lifestyle and stage appearances earned him the nickname Mr. Showmanship. Early Life Liberace was born in the Milwaukee suburb of West Allis, Wisconsin. His father was an Italian immigrant, and his mother was of Polish descent. Liberace began playing the piano at age 4, and his prodigious talent was discovered at an early age. At age 8, Liberace met the legendary Polish pianist Ignacy Paderewski backstage at a Pabst Theater concert in Milwaukee. As a teenager in the Great Depression, Liberace earned money performing in cabarets and strip clubs despite disapproval from his parents. At age 20, he performed Liszts Second Piano Concerto with the Chicago Symphony Orchestra at the Pabst Theater and subsequently toured the MIdwest as a piano player. Personal Life Liberace often hid his private life as a gay man by allowing public stories about romantic involvement with women to gain traction. In 2011, actress Betty White, a close friend, stated that Liberace was gay and she was often used by his managers to counter homosexual rumors. In the late 1950s, he sued the U.K. newspaper Daily Mirror for libel after it published statements implying that he was gay. He won the case in 1959 and received more than $20,000 in damages. In 1982, Liberaces 22-year-old former chauffeur and live-in lover of five years Scott Thorson sued him for $113 million in palimony after he was fired. Liberace continued to insist that he wasnt gay, and the case was settled out of court in 1986 with Thorson receiving $75,000, three cars, and three pet dogs. Scott Thorson later said that he agreed to settle because he knew that Liberace was dying. His book Behind the Candelabra about their relationship was adapted as an award-winning HBO film in 2013. Music Career In the 1940s, Liberace reworked his live performances from straight classical music to shows that included pop music. it would become a signature element of his concerts. In 1944 he made his first appearance in Las Vegas. Liberace added the iconic candelabra to his act after seeing it used as a prop in the 1945  film A Song To Remember about Frederic Chopin.   Liberace was his own personal publicity machine performing from private parties to sold-out concerts. By 1954, he earned a record $138,000 (more than $1,000,000 today) for a concert at New Yorks Madison Square Garden. Critics panned his piano playing, but his sense of showmanship endeared Liberace to his audiences.   In the 1960s, Liberace returned to Las Vegas and referred to himself as, a one-man Disneyland. His live Las Vegas shows in the 1970s and 1980s often earned more than $300,000 a week. His final stage performance took place at Radio City Music Hall in New York on November 2, 1986. Although he recorded almost 70 albums, Liberaces record sales were relatively small compared to his celebrity. Six of his albums were certified gold for sales. TV and Films Liberaces first network television program, the 15-minute Liberace Show, debuted in July 1952. It didnt lead to a regular series, but a syndicated film of his local live show gave him widespread national exposure. Liberace made guest appearances on a wide variety of other shows in the 1950s and 1960s including The Ed Sullivan Show. A new Liberace Show started on ABC daytime in 1958, but it was canceled after only six months. Liberace eagerly embraced pop culture making guest appearances both on the Monkees and Batman in the late 1960s. In 1978, Liberace appeared on the Muppet Show, and, in 1985, he appeared on Saturday Night Live.   From early in his career, Liberace was interested in earning success as an actor in addition to his musical talents. His first film appearance occurred in the 1950 movie South Sea Sinner. Warner Bros. gave him his first starring role in 1955 in the film Sincerely Yours. Despite a big budget advertising campaign, the movie was a critical and commercial failure. He never again appeared in a lead role in a film. Death Outside of the public eye, Liberace was tested positive for HIV by his personal physician in August 1985. More than a year before Liberaces death, his lover of seven years, Cary James Wyman, was also tested positive. He later died in 1997. Another lover named Chris Adler later came forward after Liberace died and claimed that he received the HIV virus from sex with Liberace. He died in 1990. Liberace kept his own illness a secret until the day he died. He did not seek any medical treatment. One of Liberaces last public interviews took place on TVs Good Morning America in August 1986. During the interview, he hinted that he might be sick. Liberace died of complications of AIDS on February 4, 1987, at his home in Palm Springs, California. At first, a range of causes of death were publicized, but the Riverside County coroner performed an autopsy and declared that those close to Liberace conspired to hide the real cause of death. The coroner stated it was pneumonia as a complication of AIDS. Liberace was buried at Forest Lawn, Hollywood Hills Cemetery in Los Angeles, California. Legacy Liberace achieved his fame in a fashion unique to his own personal style. His presentation of shows as a piano-playing entertainer borrowed from classical music traditions, flamboyant circus-style shows, and the intimacy of piano bars. Liberace maintained an unparalleled connection to his core audience. Liberace is also recognized as an icon among gay entertainers. Although he fought against being labeled as homosexual during his lifetime, his sexual orientation was widely discussed and recognized. Pop music legend Elton John has stated that Liberace was the first gay person he remembered seeing on television, and he considered Liberace to be a personal hero. Liberace also played a key role in the development of Las Vegas as an entertainment mecca. He opened the Liberace Museum in Las Vegas in 1979. It became a key tourist attraction along with his own live shows. The proceeds from the museum benefited the Liberace Foundation of Performing and Creative Arts. After 31 years, the museum closed in 2010 due to declining admissions.

How Buffer Achieves Continuous Growth Through Content Marketing

How Buffer Achieves Continuous Growth Through Content Marketing In the world of content marketing, there are few startups out there that have it more figured out than Buffer. With an average of 1900 shares per post, they have to be doing something right. For Buffer, though, content marketing is more than a mere marketing tactic – its a channel for growth. In fact, its their primary channel for growth. In the early days of Buffer, co-founder Leo Widrich was known for conducting  an  aggressive guest blogging campaign as a way to stimulate early growth. It worked, and now Buffer has a dedicated team of two carrying the torch forward. We caught up with Content Crafter Kevan Lee to see if we could learn more about the secrets to Buffers success. 1. Tell us about yourself. Why did you start  doing content marketing? I have the privilege of creating content for Buffer. My daily duties include writing helpful blog posts about social media and productivity, sending emails to our awesome customers, and sharing updates on the Buffer social media accounts. I’ve been writing in one form or another ever since I can remember. My journey took me to journalism school, traditional marketing, and then content marketing. I’ve been blogging, sharing, and creating online for the past eight years. 2. How big is your content marketing team? We’re fortunate at Buffer to have a team of 26 who can all write amazing stories and create awesome content. Our content marketing team of two – me and Courtney, our head of content marketing – love being able to lean on others for help as we fill our calendars with content and stories. On a day-to-day basis, the two of us take the majority of the content tasks, with helpful advice from Leo, our co-founder and the original voice on the blog. 3. What has been the most noticeable effect for Buffer from content marketing? Early on, we gained all of our new customers from content marketing. I believe it was right near 100 percent of new users who arrived via the content marketing tactics that Leo employed–guest blogging being one of the main routes. 4. What is the biggest challenge you have when it comes to your team’s workflow, communication, and content creation? Our challenge is one I love havingthere are so many different things we want to do and just not enough time to do them all! As as a team of two, we’ve chosen to focus on the aspects that have the biggest impact on our goals. As the team grows, we’d love to explore some additional avenues for content. 5. Do you set specific goals as far as to what your content marketing would look like, and what kind of measurable results you’d get? We’ve tried to identify the biggest opportunities for growth in our metrics, e.g. low traffic and high conversion where we can see great growth by bumping up the traffic side. Specifically, we’ve put a lot of emphasis on email marketing. Since making this a goal, we’ve seen great growth in this regard, doubling our signups month-over-month this summer. We’ve put an emphasis on email marketing. Since making this a goal, we’ve seen great growth6. What were you hoping would happen once you began content marketing? When I began content marketing, I was simply hoping to have an outlet to write, to help others, and to share online. I think all of those wishes have been fulfilled, and more. I think the element that took the longest to happen was feeling that I was helping others, simply because it takes a bit of an audience to get to that point. From day one at Buffer, I was so encouraged by the response and the feeling of helpfulness that comes with the Buffer blog. 7. What changes have you noticed in content marketing over the past year or so? We’ve noticed a big push toward visual content. On the Buffer blog, we’ve tried to stay ahead of the curve in this regard by creating an original image for every post we publish. It’s interesting to note that as we’re seeking stories to share via Buffer’s content suggestions, the ones with image stand out well above those without. Visual content is so much easier to share. We’ve noticed a big push toward visual content. Visual content is so much easier to share.8.What changes and trends do you think will occur in content marketing in the upcoming year? I expect marketers will continue to find new avenues to deliver their content. Visuals have been a huge step forward. Maybe the next will be SlideShare or micro-videos or snippets. Or maybe it will swing the other way where the longform, in-depth posts will be the ones that get the most attention. It seems that as content permeates the web that consumers are interested in separating the signal from the noise. That’s one area where I’m particularly interested to push forward. 9. What are the most common mistakes you see people making when it comes to content marketing? It might sound cliche, but I think that one of the most important reminders for content creators is to be helpful.  And this extends to the motivation behind a piece of content: Is it designed or written to help others or is it designed and written to bring in traffic or make a sale? You can tell the type of content that is based on the latter. Interestingly enough, content that is helpful will end up meeting the other goals, too.