A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA) The WritePass Journal

A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA) Abstract A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA) ). This review aims to review the literature on coronary CT scanning and digital subtraction angiography, their clinical applications, techniques and comparative value in coronary artery assessment and diagnosis. Cardiac Digital subtraction angiography Coronary angiography is the conventional diagnostic procedure used in coronary artery disease. It is a minimally invasive technique, whereby a catheter is placed into the radial or femoral artery and is advanced through the arterial system to the coronary arteries. A contrast agent is then injected at the aortic root and allows visualization of the arteries using x-ray in real time at up to 30 frames per second. This allows a view of the extent, location and severity of coronary obstructive lesions such as atherosclerosis and enables prognostic indication (Miller et al., 2008). Coronary angiography also enables catheter placement either side of the lesion to assess pressure changes and determines the degree of flow obstruction (Miller et al., 2008). . Digital subtraction angiography (DSA) again works by introducing a contrast agent into the coronary arteries and taking x-rays in real time, however a pre image is taken by x-ray. This allows for the post images to be subtracted from the original mask image, eliminating bone and soft tissue images, which would otherwise overlie the artery under study (Hasegawa, 1987). Unlike conventional angiography, it is possible to conduct DSA via the venous system, through accessing the superior vena cava via the basillic vein (Myerowitz, 1982). This removes the risks associated with arterial cannulation (Mancini Higgins, 1985). The procedure can also be performed with a lower dose of contrast agent and be done more quickly therefore eliminating constraints of using too much contrast during a procedure (Myerowitz, 1982). Whilst DSA is the gold standard in arterial imaging of carotid artery stenosis (Herzig et al., 2004), the application of DSA to the coronary arteries is limited due to motion artefacts associated with each heartbeat and respiration (Yamamoto et al., 2009). There are numerous cardiac clinical applications of DSA, it can be used to assess coronary blood flow (Molloi et al., 1996), valvular regurgitation (Booth, Nissen DeMaria, 1985), cardiac phase (Katritsis et al., 1988), congenital heart shunts (Myerowitz, Swanson, Turnipseed, 1985), coronary bypass grafts and percutaneous coronary intervention outcomes (Katritsis et al, 1988; Guthaner, Wexler Bradley, 1985). However, others have suggested that the coronary arteries are not visualized well due to their small size, movement, their position overlying the opacified aorta and left ventricle, and confusion with other structures such as the pulmonary veins (Myerowitz, 1982). Cardiac CT Scanning Development of CT scanning in the 1990s enabled an increase in temporal resolution that was sufficient to view the beating heart, and they now provide a non-invasive technique for diagnostic and prognostic purposes. Cardiac CT scans have clinical applications that go beyond perfusion investigation, and can be used to assess structure and function of the heart (for example in electrophysiology disorders or congenital heart disease) due to its ability to provide anatomical detail (Achenbach Raggi, 2010). CT scans can be used to assess coronary artery disease with and without injection of contrast agent (Achenbach Raggi, 2010) by calcium scan or CT angiography. Coronary calcium CT scanning uses the evidence base that coronary artery calcium is a correlate of atherosclerosis (Burke et al., 2003) and is a strong prognostic predictor of the future development of coronary artery disease and cardiac events (Arad et al., 2000; Budoff et al., 2009; Achenbach Raggi, 2010). Calcium is easily depicted on CT scan due to its high CT attenuation, and is classified according to the Agatson score, which considers the density and area of the calcification (Hoffman, Brady Muller, 2003). Coronary CT angiography (CTA) allows visualization of the coronary artery lumen to identify any atherosclerosis or stenosis within the vessels. Patients are injected intravenously with a contrast agent and then undergo a CT scan. There are limitations regarding the suitability of patients for coronary CTA due to prerequisites of sinus rhythm, low heart rate and ability to follow breath-holding commands. Additionally, obesity presents a problem for patients that cannot fit into the scanner and affects the accuracy of the procedure. (Achenbach Raggi, 2010). Comparison of cardiac DSA and cardiac CT scanning The technical differences between cardiac DSA and cardiac CT scanning give rise to differences in the clinical indications for the procedures, their diagnostic efficacy and also different risks or relative benefits to the patients. Due to the nature of the images produced by coronary CTA and DSA, each lends itself to different indications for use. Whilst coronary DSA provides imaging of all aspects of perfusion, CTA used with contrast agent also provides this however has the additional advantage of being able to assess structure and function of the heart. Coronary CTA has been shown to have a high accuracy at detection and exclusion of coronary artery stenoses (Achenbach Raggi, 2010). In a multicentre trial conducted by Miller et al. (2008), patients underwent coronary calcium scoring and CT angiography prior to conventional invasive coronary angiography. The diagnostic accuracy of coronary CTA at ruling out or detecting coronary stenoses of 50% was shown to have a sensitivity of 85% and a specificity of 90%. This showed that coronary CTA was particularly effective at ruling out non-significant stenoses. Additionally, coronary CTA was shown to be of equal efficacy as conventional coronary angiography at identifying the patients that subsequently went on to have revascularisation via percutaneous intervention. This was shown by an area under the curve (AUC), a measure of accuracy of 0.84 for coronary CTA and 0.82 for coronary angiography. Miller et al.’s (2008) study included a large number of patients at different study sites, and additionally represented a large variety of clinical patient characteristics. The author’s claim that these factors contribute to the strength and validity of the study findings, and suggest that in addition to using patients with clinical indications for anatomical coronary imaging, should be used as evidence that coronary CTA is accurate at identifying disease severity in coronary artery disease. Miller et al. (2008) did however,, find that positive predictive and negative predictive values of coronary CTA were 91% and 83% respectively and therefore suggested that coronary CTA should not be used in place of the more accurate conventional coronary angiography. A low positive predictive value (in relation to the prevalence of disease) was proposed to be due to a tendency to overestimate stenosis degree as well as the presence of artefacts leading to false positive interpretation (Achenbach Raggi, 2010). Other research providing comparison between coronary CTA and conventional coronary angiogram has highlighted variability in results. A meta-analysis conducted by Gorenoi, Schonermark and Hagen (2012) investigated the diagnostic capabilities of coronary CTA and invasive coronary angiography using intracoronary pressure measurement as the reference standard. The authors found that CT coronary angiography had a greater sensitivity than invasive coronary angiography (80% vs 67%), meaning that coronary CTA was more likely to identify functionally relevant coronary artery stenoses in patients. Despite this,, specificity of coronary CTA was 67%, compared to 75% in invasive coronary angiography, meaning that the technique was less effective at correctly excluding non-diagnoses than invasive coronary angiogram. This research appears to contradict the power of cardiac CTA at excluding diagnoses of coronary artery stenosis as suggested by Miller et al. (2008), he study did combine evidence from over 44 studies to provide their results and therefore had a large statistical power. The authors interpret the results in light of the clinical relevance of cardiac imaging, suggesting that patients with a higher pretest possibility of coronary heart disease will likely require invasive coronary angiography for revascularisation indicating that coronary CTA may be a helpful technique in those patients with an intermediate pre-test probability of coronary heart disease that will therefore not require invasive angiography. Goldberg et al. (1986) investigated the efficacy of DSA in comparison to conventional coronary angiography in 77 patients. They found that the two angiograms agreed within one grade of severity in 84% of single cases and 90% of multiple cases, identifying both patent and lesioned arteries. The results led the authors to conclude that there was no significant difference between the two methods and that DSA could be used in selective coronary angiography to find results comparable to that of conventional angiography. In addition to being a small study into the efficacy of DSA, the study also had several sources of inherent variability that should be considered when interpreting the results. These included differing sizes of digital imaging screen and non-use of calipers, meaning that the interpretation of the images could vary throughout the study. The authors also suggest that whilst showing strong support for the use of DSA in coronary artery disease, the technique may not actually p ermit better prognostic determinations or clinical judgements that are better than conventional angiography, and therefore the further implementation of the techniques may not be founded or necessitated. More recently, there has been further research looking at the effectiveness of DSA as a way of measuring coronary blood flow. Whilst motion artefacts have proven a problem in lots of past research (Marinus, Buis Benthem, 1990; Hangiandreou, 1990), recent research has developed methods to minimise these. Moilloi and colleaues (1996) showed that using a motion-immune dual-energy digital subtraction angiography, absolute volumetric coronary blood flow could be measured accurately and thus provide an indication of the severity of any arterial stenosis.This may provide further suggestion for clinical implementation of DSA. Although these studies provide evidence for the efficacy of cardiac DSA and CTA, they often make comparisons to conventional angiography. This is useful as a baseline comparison, however it is difficult to make comparisons between the two procedures directly due to less available evidence making direct comparisons. Lupon-Roses et al. (1985) conducted a study investigating both coronary CTA and venous DSA. The study looked at the efficacy of both techniques at diagnosing patency of coronary artery grafts compared to the control conventional angiography. CT was shown to diagnose 93% of the patent grafts and 67% of the occluded grafts whereas DSA correctly diagnosed 98% and 100% of patent and occluded grafts respectively. Interestingly, the DSA picked up the 11 grafts that were misdiagnosed by CTA and the CTA picked up the 2 grafts misdiagnosed by the DSA. This data may suggest that individually, DSA has a better profile for diagnosis of coronary artery occlusion, however if the two procedures are used in combination exclusion of patent arteries and diagnosis of occluded arteries would be effective (Lupon-Roses et al., 1985). Coronary DSA and CTA are both non-invasive procedures (unlike the conventional coronary angiography where a wire is placed in the coronary vasculature). With the only invasive part of the procedure being the injection of the contrast material into a vein. This presents a significant advantage to both procedures over that of conventional angiography, and may even permit investigation on an outpatient basis (Meaney et al., 1980). Similarly, both DSA and coronary CTA are favoured because of their intravenous approach, eliminating the risks of bleeding or arterial injury from an intra-arterial catheterization and being able to be used in those with limited arterial access. However, although the intravenous approach used in cardiac DSA makes it favourable, it does lead to difficulty with visualisation of the coronary arteries due to the overlying iodinated pulmonary and cardiac structures (Mancini Higgins, 1985). Therefore,, intra-arterial DSA is also sometimes used (Yamamoto et al., 200 9). As with all CT scanning, coronary CTA carries with it a dose of ionizing radiation (Brenner Hall, 2007). Studies have estimated that for diagnostic CT scanning, patients are on average exposed to 12mSv of radiation during the procedure, the equivalent of 600 x-rays (Hausleiter et al., 2009). Estimates of radiation doses associated with conventional coronary angiography are lower than that of coronary CTA at 7mSv (Einstein et al., 2007). Additionally, DSA technique reduces the radiation dose from that of conventional coronary angiography as the vessels are visualised more clearly (Yamamoto et al., 2008). The dangers of radiation exposure are increased risk of developing cancer, skin injuries and cateracts (Einstein et al., 2007). It is therefore important that the benefits of conducting the procedure greatly outweigh the risk of radiation exposure. CT calcium scanning provides a low radiation dose at around 1mSv (Hunold et al., 2003). Cardiac CT calcium scanning does not require administration of a contrast agent, unlike in coronary CTA and DSA that use iodine based contrast agents. The risks associated with contrast agent include nephrotoxicity and risks of hives, allergic reactions and anaphylaxis (Maddox, 2002). The amount of contrast agent used is partly dependent on the length of the procedure and how clearly the arteries can be visualised. For this reason, both cardiac CTA and DSA use less contrast agent that conventional coronary angiography (Brant-Zawadzki, et al., 1983). CT calcium scanning of the coronary arteries is therefore recommended in those with less likelihood of coronary artery disease (NICE, 2010). Both coronary CTA and DSA require interpretation by trained physicians, and the importance of training and achieving intra-rater reliability should not be underestimated (Pugliese et al., 2009). Conclusion Overall, both coronary CT and DSA have been demonstrated as effective procedures for the imaging of the coronary arteries in CAD (Achenbach Raggi, 2010; Miller et al., 2008; Moilloi et al., 1996; Goldberg et al., 1986). Whilst cardiac CT scanning does provide a wider range of clinical applications, allowing assessment of perfusion as well as cardiac structure and function (Achenbach Raggi, 2010), coronary DSA has many applications that allow assessment of coronary blood flow (Molloi et al., 1996; Katritsis et al, 1988; Booth, Nissen DeMaria, 1985; Guthaner, Wexler Bradley, 1985; Myerowitz, Swanson, Turnipseed, 198). Both cardiac DSA and CTA procedures have their advantages. As non-invasive procedures, these techniques pose less risk to patients, and enable the possibility of outpatient investigation, to be used to rule out diagnoses and to avoid inappropriate invasive coronary angiogram (Gorenori et al., 2012). Additionally, intravenous access is preferential to arterial cannulation for the contrast infusion, removing the risks associated with bleeding or intra-arterial injury. Cardiac DSA exposes the patient to a lower dose of radiation that coronary CTA (Hausleiter et al., 2009; Yamamoto et al., 2008; Einstein et al., 2007), which is beneficial at reducing the risk of genetic mutations and cancer. Cardiac CTA and DSA also have their common disadvantages. The use of contrast agent may present side effects for the patient including kidney damage and risk of allergic reactions and anaphylaxis (Maddox, 2002). For this reason, calcium CT scanning can be useful in patients that are not at high likelihood of coronary artery disease (NICE, 2010b). Additionally, both cardiac DSA and CTA are subject to motion artefacts from respiration and heart beats, which can cause difficulties with interpretation (Achenbach Raggi, 2010; Yamamoto et al., 2009). In the case of cardiac CTA, this excludes a subset of patients that are unable to follow commands and those who have high heart rates. Overall, cardiac CTA and cardiac DSA are effective, non-invasive imaging techniques for assessment of coronary artery disease. Whilst they are not the gold standards in cardiac monitoring, they can provide important diagnostic information without exposing patients to the risks of invasive angiography. Due to this, their use should be weighted against clinical need, the risks of the procedures, and the suitability of the patient. Interpretation of cardiac CTA and DSA imaging should be by trained individuals. References Achenbach, S., Raggi, P. (2010) Imaging of coronary atherosclerosis by computed tomography. European Heart Journal. 31:1442 Arad, Y., Spadaro, L. A., Goodman, K., Newstein, D., Guerci, A. D. (2000). Prediction of coronary events with electron beam computed tomography.Journal of the American College of Cardiology,  36(4), 1253-1260. Booth, D. C., Nissen, S., DeMaria, A. N. (1985). 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Subscription levels are expected to continue to grow, however, it should be noted that while there were 73.5 million subscriptions in UK in 2007, it has been cited that nine million subscriptions are for SIM cards that are inactive and a further 7.7 million that are barely active. Mobile phone subscriptions are forecast to increase in 2008 to 76 million subscriptions. Currently the UK represents approximately 9% of the European market and by 2010 it is forecast to have 78 million subscriptions. (Mintel 2008) There are five mobile phone networks currently operating in the UK : O2, T-Mobile, Orange, Vodafone and most recently 3. Vodafone and O2 (formerly BT Cellnet) are the largest and oldest. These two networks were joined by T-Mobile (formerly One 2 One) swiftly followed by Orange. All of these companies now operate digital networks. In addition, there are many virtual networks operating on these major networks, packaged under a different name. e.g. Virgin, OneTel, Lycatalk etc. All the above mentioned facts shows that there is a huge market for Mobile service providers in U.K. Mobile phone is everyones need and there is a large customer base who uses the services of more than one network provider. 4. Justification for the choice of research Over the last decade organizations of all types and sizes have increasingly come to understand the importance of customer satisfaction. It is a renowned fact that it is far less costly to keep existing customers than to make new ones. It is becoming accepted that there is a strong link between customer retention, customer satisfaction and profitability. In a large area of public sector customer satisfaction itself is the measure of success (Nigel Hill, 2002). Mobile phone network industry is a giant industry in U.K. I chose this research topic because I personally observed there is a huge competition in this industry, and the industry is prone to face problems of customer decay. The average business loses between 10 and 30 percent of its customers each year; but they often dont know which customer they have lost, when they were lost, why they were lost or how much sales revenue and profit this customer decay has cost them (Nigel Hill and Jam Alaxender, 2002, p 3). A loyal customer fe els committed towards the organization and results in profit and growth to the organization. In this highly competitive era, every company tries to offer uniqueness and best value for money, an educated and smart customer has some determinants to choose which organization to stay committed with and which company to switch over. 5. Research objectives 5.1 To find out the right service gap Service gap is the difference between the present quality of service and ideal quality of service. It is very important for an organization to know the right service gap so as to focus on narrowing down that service gap and offer better services to the customer. Nigel Hill and Jim Alaxender have specified five types of service gaps (Nigel Hill and Jim Alaxender, 2002, p 5.): Promotional Gap -When what is said about the service differs from the standards actually delivered. Understanding Gap when managers perceptions of customers expectations are inaccurate Procedural Gap when customers expectations are not translated into appropriate operating procedures / system. Behavioural Gap When the service delivered is different from the specifications of the service. Perception Gap When the level of service perceived by customers differs from the service actually provided. 5.2 To find out the degree of customer loyalty There are different levels of customer loyalty referred as a ladder of pyramid in literature. These levels of loyalty vary from the customer perspective. These are defined as follows (Nigel Hill and Jim Alaxender, 2002, p 16.): Suspects When suspects are unaware of the product or have no inclination to purchase it. Prospects When customers have some attraction towards the organization, but they have not yet taken the step of doing business yet. Customers usually one-off purchaser or may be sometimes repeat buyers, but no real feelings towards organization. Clients Repeat customers having positive feeling towards organization, but their support is passive rather than active. Advocates Actively supporting clients who recommend organization to others. Partners Strongest form of loyalty, where both parties see mutual benefit in partnership. Predicting the right level of customer loyalty towards an organization helps in strategically planning the measures to enhance customer trust and shifting from bottom to top level of the loyalty pyramid. There is usually a homogenous segment of customers lying at each level. Identifying that segment and planning accordingly will help in increasing customer retention. 5.4 To analyse the factors that affects customer satisfaction and loyalty. A questionnaire will be designed with an aim to find out first two objectives and carrying out customer expectations from their mobile service provider. In-depth analysis of the data obtained will bring out the factors that affect customer satisfaction and loyalty. The organization can thus underpin those factors in their customer relationship process and try to retain customer commitment. A committed customer stay longer, buy more often, buy more range, spend more, recommend more, consider competitors less and feel committed. (Nigel Hill, Jim Alaxender, 2002) 6. Research Methods The research is clearly classified as exploratory study. This kind of study is a valuable mean of clarifying the understanding of a problem (Saunders et al. 2003, p.96). The above research objectives will be achieved using qualitative primary data in the form of unstructured questionnaire. The primary data will be collected from the below mentioned sample size in the form of unstructured questionnaires. The research strategy that will be carried out will be Survey in the form of unstructured questionnaire. The research will be exploratory study as the precise nature of the problem is not sure (Saunders et al. 2007, p.138). 7. Data collection and analysis Both primary as well as secondary data will be used for this research. Secondary data will be obtained from various sources to obtain theoretical background for carrying out the research. The secondary data collection source would be :- Research Methods for Business Students Mark Saunders, Philip Lewis and Adrian Thornhill, 2003. Handbook of customer satisfaction and loyalty measurement Nigel Hilla and Jim Alexander, 2002. Online library resources e.g. Mintel, Emerald etc. After getting the theoretical background for carrying out the research, Primary data would be collected from the sample size in the form of unstructured questionnaires. Unstructured questionnaire would be preferred as compared to other survey methods as it will be less complicated and deems fit for carrying our research like this. . 8. Time scale and resources I have sufficient resources to carry out this research. I have divided my research plan into activities with clear completion time frames and my tendency would be complete the research within the designed time frame. Month Day Activities March 1-15 Further reading on key theories and concepts involved in research and drawing relevant information for the literature review. Mid March to April 20-30 Commencement and finishing of critical literature review drafts May to June 5-30 Collection and compilation of research data July to mid August 1 17 Analyzing the data and writing the first research draft. Mid August to Mid September 17 30 Compiling the final research and carrying out conclusions and recommendations. References Mark Saunders, Philip Lewis and Adrain Thornhill (2003) Research methods for business students 3rd Edition. FT Prentice Hall Financial Times Pearson Education U.K) Mark Saunders, Philip Lewis and Adrain Thornhill (2007) Research methods for business students 4th Edition. FT Prentice Hall Financial Times Pearson Education U.K) Nigel Hill and Jim Alexander (2002) Handbook of Customer Satisfaction and Loyalty Measurement. 2nd Ed. USA : Gower Publishing Company. Mintel (November 2008) UK Mobile Services and Network Providers.

Windows Server Essay -- Computers Software Essays

Windows Server There are some key differences between Windows DNS Services servers and non-Windows DNS server appliances in the areas of AD integration and security. For example, some non-Windows DNS server appliances lack complete AD integration features. Conversely, Windows DNS Service servers don't support encrypted zone transfer and update features like some non-Windows DNS server appliances do. (ref: DNS server appliances) One cant use any DNS service. Active Directory requires that the DNS support dynamic updates via RFC 2136; Windows 2000 has the advantage of being the only one that does it out of the box Those environments that already have Internet domains and DNS servers on their networks have two options.Either replace their existing DNS servers with Windows 2000 boxes or create a new internal domain to host the AD. For example, if your company is called WidgetCo, and all your internal servers are TCP/IP hosts on widgetco.com, you either need to create a sub-domain called ad.widgetco.com or you need to create something like widgetco.net, as one of my associates had to do at a large Manhattan-based international law firm. It's possible to make Unix DNS servers like BIND (Berkeley Internet Name Daemon) support Windows 2000 dynamic DNS, but it's a little tricky. Microsoft TechNet's white paper on Windows 2000 DNS provides information on getting your non-MS DNS to comply with RFC 2136. Chances are you'll need to upgrade your Unix server to the latest version of BIND, version 8.2, to make it work. Creating an entirely new domain may be less of a headache. (ref: How Microsoft went wrong with Active Directory) When Microsoft started to talk about AD and AD's DNS integration, the company said AD would operate with any DNS implementation that is compatible with the standards for dynamic DNS. DDNS is a key piece of the AD model. As the development of AD progressed, Microsoft downplayed the support for non-Win2K DNS servers. At press time, Microsoft claimed that Win2K will be compatible with UNIX's Berkeley Internet Name Domain (BIND) 8.2, but to fully utilize AD's features, you will need to use Win2K's DNS. UNIX advocates believe that NT isn't stable enough to provide the 24 X 7 service that DNS services require and that the Microsoft DNS implementations aren't sufficiently compatible with the open-source UNIX standards. Win2K and NT advo... ... Native Mode? When a domain is first installed, it is in mixed mode. The mode of operation can be changed from mixed mode to native, but this is not reversible. In native mode, Windows NT 4.0 Domain Controllers cannot participate in the domain. (ref :Step by step guide) Changing the Domain Mode Windows 2000 domains operate in one of two modes: ï‚ §Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Mixed Mode. Allows domain controllers running both Windows 2000 and earlier versions of Windows NT ® Server to co-exist in the domain. In mixed mode, the domain features from previous versions of Windows NT Server are still enabled, while some Windows 2000 features are disabled. You can change to native mode after making sure all domain controllers in your domain are running Windows 2000 Server. 4.Your organisation contains four geographic locations connected via slow links. Currently all locations belong to the one Domain with a number of domain controllers all located at one site. Users are complaining of slow authentication and access to AD information. Describe 2 different options you could consider to improve the performance of the Domain. Recommend one of the options providing reasons for your choice.

The First Modern War

Samuel Santiuste Ms. Engelken US History I Honors May 13, 2011 The First Modern War While reading history, we typically see that wars were typically fought with soldiers in close- order formations with a musket that would be fired in unison on command. Everything changed after the American Civil War, a conflict to determine the fate of slaves in the Union, erupted. Today many historians consider the Civil War as the first modern war because it depended on: heavy industry, fast communication and transportation. But this time all of these new technologies were used to its full potential. As a result new weapon technology was mass produced which inflicted heavy losses on both the Union and the Confederate sides and resulted in improved battlefield medicine. Years before the Civil War, soldiers would normally carry muskets that had a fire range of about 250 yards. But although this weapon had an amazing range, the musket only held and fired one bullet at a time and it hit random targets. The accuracy of the musket was from about 80 yards and this caused many of the battles to be fought at a close range. Then, in 1848 the French officer named Claude-Etienne Minie took the design of a bullet that expanded upon fired and â€Å"simplified and improved on earlier designs–including those developed by Britain's Captain John Norton (1818) and William Greener (1836)† to make the bullet that bears its name: the Minie ball (Minie Ball). This new bullet combined with the rifle made a terrific duo because the range of the weapon was from 200-250 yards with a terrific accuracy. To show the bullet’s power alone, during the Crimean War of 1853-56 â€Å"the bullet so improved the effectiveness of infantry troops that 150 soldiers using the Minie ball could equal the firing power of more than 500 with a traditional musket and ammunition† (Minie Ball). When this weapon was introduced to the Civil War, the old model of warfare became obsolete right away because the infantry along with the cavalry could not charge against the enemy as they used to. Other weapons that came into action in the Civil War were not as deadly as the Minie ball but had a big impact on surviving. Despite the fact that the Minie ball was easy to load, soldiers still had to pause in the middle of the action to reload their guns, and this made them easy targets. By 1863, there was a new weapon that solved this problem called repeating rifle because it could fired more than one bullet before the needing of a reload. The most famous type was the Spencer carbine. But like many other technology, this weapon was only available to the Northerners. Many Southerners thought that this weapon was unfair and one Union soldier once wrote: â€Å"they say we are not fair, that we have guns that we load up on Sunday and shoot all the rest of the week† (Civil War Technology). At the end of the war, the statistics showed that the Minie ball combined with the rifle did the most damage because â€Å"with more than 200,000 soldiers killed and more than 400,000 wounded, 90 percent of these causalities were caused by these weapons† (Minie Ball). On the same year that the Civil War started, President Lincoln ordered a blockade on the Confederates to stop their cotton trade and split the confederacy. So to counter attack the Union, many advances in naval warfare were flourishing which led to the built of the H. L. Hunley, which was the first ever effective submarine developed by the Confederates. This Confederate submarine was created to destroy the Union blockade wooden ships with the use of torpedoes that were attached along a long steak that exploded upon contact or by a timer. But before the submarine was ready to attack, it sank three times and on the fourth tried â€Å"it was sent out to attack the U. S. S. Housatonic, and detonated its torpedo, sinking the Housatonic and thereby becoming the first submarine to ever sink an enemy vessel† (Dutch). Despite the best efforts the submarine sank with the blast. Another incredible invention that changed the nature of warfare in the seas was when the ironclad warships came into action. This time both sides had their own version of the ironclad which was powered by a steam engine: Union had the U. S. S. Monitor and the Confederates the C. S. S. Virginia or Merrimack. Once again the Confederates tried to destroy the Union ships using an ironclad â€Å"built upon the charred remains of a burnt wooden warship, clad completely in iron plating down to the waterline and bristling with cannons† (White). This warship just went straight for the blockade in Virginia, and although it was hit by explosives and other heavy artillery the damage was minimal. And this is just a brief view of what might the battle would have been like by Professor J Rickard with the Virginia: On 8 March 1862 she steamed out of Norfolk to attack the Union blockading fleet. Her ten guns were opposed to 219 Union guns on five ships, but the Union ships didn’t stand a chance. First to go was the U. S. S. Cumberland (24 guns), rammed and sunk. The only serious damage inflicted to the Virginia was that her ram broke off and remained stuck in the Cumberland. All of this meant that the Union needed reinforcement, so they sent the Monitor to save the day. These ships battled for â€Å"several hours as their shells and shot bounced off each other's thick armor plating† and the match might have ended in a tie as there were no records telling who won (White). As the iron-clad demonstrated their power, the old wooden ships became obsolete. Even though there was fascinating technology being used in the Civil War, the only two â€Å"weapons† that President Lincoln that used the most were the train and the telegraph. Although the railroads were still a new concept because they were not used much for military purposes, they were still used to attack the enemy and replenish troops. The Union owned about 21,000 miles of railroad tracks while the Confederates only owned about 9,000 miles. Since the beginning of the war both sides used trains to transport ammunition and soldiers to the front lines faster than ever before. Because the trains played a very important role in the war, the enemy used â€Å"rail twisters and devices to blow up railroad bridges and other infrastructure and even some troops specialized in destroying railroad equipment as their sole-role in the war† (AE Aeragon) . Most of the time trains were used for transportation, but on special occasions they were used as rams. Sometimes troops would send trains at full speed to â€Å"damage an enemy train or railroad facilities, or to attack troops and even to destroy bridges† (Koenig). This experienced Confederates soldiers when they saw a train on flames aiming straight for them. Now, the telegraph was located along the railroad tracks and this meant that the North had the upper hand because they have the most railroad miles. The telegraph helped President Lincoln from the White House â€Å"to monitor battlefield reports, lead real-time strategy meetings and deliver orders to his men† (Civil War Technology). This turn out to be a great advantage for the North because they still required the technology and industry to carry out communication tasks. And by 1862 the U. S. Military Telegraph Corps â€Å"trained 1,200 operators, strung 4,000 miles telegraph wire and had sent more than 1,000,000 messages back and for† (Koenig). This alone can tell that during this war that the president was actually involved more than in past wars. Throughout the entire Civil War, diseases were killing more people than weapons because people had little knowledge about the silent killers called germs. Since the beginning of the Civil War in the spring of 1861 â€Å"medically, the United States was woefully prepared and scientists, meanwhile, had yet to come up with the theory that germs cause diseases† (Sohn). This meant that doctors did not know that they should always wash their instruments before operating and the hospital hygiene was very poor which led to disease breakouts. But problems led to many medical advances such as the protocol to treat the injuries. This system was created by Jonathan Letterman, a Union surgeon, who â€Å"created a well-organized system of care that began with triage close to the source of harm and was followed by rapid transportation to a series of clinics, hospitals and specialists† (Sohn). This medical protocol is still essential today. While there medical advancements, many improvements on neurology came about. Physicians began â€Å"the study of phantom limbs, the perception of a missing arm or leg as present and painful† (White). The American physician S. Weir Mitchell discovered phenomenon such as the shell shock and posttraumatic stress syndrome. One of the ways that physicians noticed these problems were when soldiers would freeze or started to shake wildly and many thought it was because that person was a coward. So Mitchell and his colleague, Jacob da Costa, â€Å"came into a conclusion which was that the soldiers were suffering from mental problems, stress and heart diseases† (White). To treat these problems, they said it was necessary the removal and rest from the source causing the stress. The Civil War, an event that could have or could have not being avoided, shaped the future of the entire world. The war had a great impact on anything that ranged from weapons to medicine. It also leaded to the creation of new technology such as the telephone and the improvement on the medical field. Although the war brought many innovations to the United Sates, it is still the bloodiest one in the American history because people from the same nation were being killed and it is similar to what the British Novelists Agatha Christie said about war: One is left with the horrible feeling now that war settles nothing; that to win a war is as disastrous as to lose one. Works Cited â€Å"Civil War Technology. † 2011. The History Channel website. Apr. 27 2011, 11:04 . Dutch, Steven. â€Å"The First Modern War and the Last Ancient War. † University of Wisconsin – Green Bay. N. p. , 02 Jun 2010. Web. 27 Apr 2011. . Koenig, Alan R. â€Å"Railroad's Critical Role in the Civil War. † America's Civil War 1996: n. pag. Web. 27 Apr 2011. . â€Å"Minie Ball. † 2011. The History Channel website. Apr. 27 2011, 11:03 . Rickard, J (1 May 2006), American Civil War: The Blockade and the War at Sea, . Sohn, Emily. â€Å"How the Civil War Changed Modern Medicine. † Discovery News. N. p. , 08 Apr. 2011. Web. 27 Apr 2011. . Stevens, Anthony. Roots of War and Terror. New York: Cromwell Press Ltd, 2044. 212. eBook. â€Å"The US Civil War, the First Modern War. † AE Aeragon. N. p. , n. d. Web. 27 Apr 2011. . White, David. â€Å"Born in the USA: A New World of War. † History Today 60. 6 (2010): 12. Points of View Reference Center. EBSCO. Web. 27 Apr. 2011.

Amiri Bakara †Somebody Blew Up America Essay Example

Amiri Bakara – Somebody Blew Up America Essay Example Amiri Bakara – Somebody Blew Up America Paper Amiri Bakara – Somebody Blew Up America Paper Amiri Bakara – Somebody Blew up America Amiri Bakara was born in Newark, New Jersey on October 7, 1934. He was born as Everett Leroi Jones. In 1952 he changed his name to Leroi Jones and in 1967 he changed it to Amiri Bakara. He lived with his parents, his father who was a postal supervisor and his mother who was a social worker. He attended Rutgers University, Colombia University and Howard University studying philosophy and religious studies. He did not obtain a degree from any of the three colleges. Instead, he joined the United States Air Force in 1954 but was later dishonorably discharged because of the discovery of so called communist writings. After his time in the Air Force, Bakara moved to Greenwich Village and found Totem Press after becoming interested in jazz music. That same year, 1958, he met and married Hettie Cohen and together they worked as editors of Yugen, a literary magazine. The experiences had a powerful influence on his later works of poetry. After the assassination of Malcolm X, Bakara left his wife and two children and moved to Harlem to become what he considered a black cultural nationalist. In 1966, Bakara married his second wife, who would later change her name to Amina Bakara. In 1967, Bakara joined the staff of San Francisco University as a lecturer. The following year he was arrested for illegally carrying a concealed weapon and for resisting arrest during riots following the assassination of Martin Luther King Jr. In the 1970s, Bakara was criticized for several poems he had written that many claimed to have anti-Jewish undertones. This is still a critique that Baraka deals with regarding his more recent works. In later years, Bakara’s 31-year old daughter was murdered and he was listed as one of America’s 101 Most Dangerous Academics in America (Wikipedia, 1). There is much controversy surrounding the work of Amiri Bakara. He often used violent and graphic imagery in his work that has been aimed at women, gay people, white people and Jews. Many people have taken offense to Bakara’s work and this dates back to his early career as well. Bakara aintains that he writes about black oppression, but often his work is blatantly racist, sexist, homophobic and anti-Semitic. The poem that this paper will racially review and critique is Somebody Blew up America, written about the September 11 attacks in New York City. Somebody Blew up America is one of Bakara’s poems that has caused much controversy among Americans in particular. The poem names specific names, including Trent Lott, Condoleezza Rice and Clarence Thomas and these people are spoken against in extreme anger. Who do Tom Ass Clarence Work for? Who doo doo come out the Colons mouth? Who know what kind of Skeeza is a Condoleeza? † (Baraka, 2001, 1). It also sites Israel as playing a part in the attacks. â€Å"Who knew the World Trade Center was gonna get bombed? Who told 4000 Israeli workers at the Twin Towers to stay home that day? Why did Sharon stay away? Who know why Five Israelis was filming the explosion and cracking they sides at the notion† (Bakara, 1). He also cites President George W. Bush as having a role in the September 11 attacks. Who the fake president† (Bakara, 2001, 1). â€Å"My writing reflects my own growth and expansion, and at the same time the society in which I have existed throughout this confrontation. Whether it is politics, music, literature, or the origins of language, there is always a historical and time/place/condition reference that will always try to explain wh y I was saying both how and for what† (Bakara Harris, preface). This is quote from Amiri Bakara when describing why he writes the things that he does. He said this before he wrote the poem Somebody Blew up America, which shows that he has been defending his work since the beginning of his writing career. Bakara once again had to defend himself and his writing when the Anti-Defamation League spoke out against this poem and the racial and personal attacks it contained. The Anti-Defamation League felt that this poem was racially directed towards white people as well as Jews. They were unimpressed with Baraka’s choice of language when providing his examples within the poem. Bakara, Amiri. (2002). I will not apologize, I will not resign. Retrieved on April 27, 2008 from amiribaraka. com/speech100202. html. Bakara, Amiri. (2001). Somebody blew up America. Retrieved on April 27, 2008 from amiribaraka. com/blew. html. Bakara, Amiri Harris, William J. (1960). The Leroi Jones/Amiri Bakara Reader. New York, NY: Thunder Mountain Press. Wikipedia. (2008). Amiri Bakara. Retrieved on April 27, 2008 from http://en. wikipedia. org/wiki/LeRoi_Jones.

Free Essays on Pygmalion Effect

Most people have heard about the Pygmalion effect, or the possibilities of effecting ones behavior by your belief in their ability. This is also known as the self fulfilling prophecy (Digest, 2003) the effect was highlighted in the play â€Å"My Fair Lady,† this was where Eliza Doolittle’s success was enhanced by Professor Higgins belief in her ability. Is it possible to affect one’s behavior by your belief in their ability, or is this just fallacy? During everyday life this theory might not be recognizable; to the average person it might not even be important. But what happens when the person effecting behavior is in the position of authority? What say a teacher, how would their opinion affect the performance of a student. Just for a moment think about the first day of a new semester, a group of students enter the room. The group consists of black, fat, skinny and white students; some are what you might call beautiful, some ugly with acne. Also mixed in with the group are the usual jocks (sport motivated) and the young teenage girls that spend their free time with daddies BMW whopping it up at the mall. At the end of the line arrive the poor, lower class students whose parents are unemployed, dad just lost his job at the mill type. You stand at the front of the classroom surveying the new recruits. Would you categorize these students, judge them in anyway? Or would you look freely across the room without any pre-judgment? Teachers all over the world encounter this problem everyday. Take the fat black student, he sits in class everyday, never takes a note and scores a 100% on the first test. What is your first reaction? Do you congratulate him, or do you try and remember who he was sitting next to? Conversely when the handsome upper class student scores 100%, is your reaction the same or different? We categorize people everyday. America is one of many countries where success is directly related to the amount of worldly poss... Free Essays on Pygmalion Effect Free Essays on Pygmalion Effect Most people have heard about the Pygmalion effect, or the possibilities of effecting ones behavior by your belief in their ability. This is also known as the self fulfilling prophecy (Digest, 2003) the effect was highlighted in the play â€Å"My Fair Lady,† this was where Eliza Doolittle’s success was enhanced by Professor Higgins belief in her ability. Is it possible to affect one’s behavior by your belief in their ability, or is this just fallacy? During everyday life this theory might not be recognizable; to the average person it might not even be important. But what happens when the person effecting behavior is in the position of authority? What say a teacher, how would their opinion affect the performance of a student. Just for a moment think about the first day of a new semester, a group of students enter the room. The group consists of black, fat, skinny and white students; some are what you might call beautiful, some ugly with acne. Also mixed in with the group are the usual jocks (sport motivated) and the young teenage girls that spend their free time with daddies BMW whopping it up at the mall. At the end of the line arrive the poor, lower class students whose parents are unemployed, dad just lost his job at the mill type. You stand at the front of the classroom surveying the new recruits. Would you categorize these students, judge them in anyway? Or would you look freely across the room without any pre-judgment? Teachers all over the world encounter this problem everyday. Take the fat black student, he sits in class everyday, never takes a note and scores a 100% on the first test. What is your first reaction? Do you congratulate him, or do you try and remember who he was sitting next to? Conversely when the handsome upper class student scores 100%, is your reaction the same or different? We categorize people everyday. America is one of many countries where success is directly related to the amount of worldly poss...

Tree in a field Essay Example | Topics and Well Written Essays - 1250 words

Tree in a field - Essay Example At the age of 15, Walter Kuhn sold the first drawing to a certain magazine; it is at this point that he began to sign his name as Walt. He would later enroll for evening art classes at Brooklyn Polytechnic Institute in 1893. Later, Kuhn lost interest on becoming artist and instead chose to sell bicycles in a shop at Brooklyn. He had a very dedicative personality and yet he would also be regarded as impulsive. By 1899, Kuhn was overwhelmed with the ideas from the American West. Though he only $60, he decided to move to California. In San Francisco, Kuhn began to draw cartoons to WASP magazine. He later moved to Paris in 1901and then enrolled in the formal class of the Academy Colarossi. He never got much exited with the learning and chose to move to Munich where he got opportunity to study under Barbizon Painter Heinrich von Zugel After 2 years, Kuhn returned to New York and found himself immersed in the booming art scene in New York. He helped manage the Kit Kat Club while at the same time he continued to work as an illustrator for local journals. The Kit Club was an organization which had a responsibility of raising funds for the scholarship at the Academy of Design. Kuhn staged his first exhibition in 1905 at Salmagundi Club, presenting himself both as a serious painter and a cartoonist. In the same year, Kuhn submitted his first illustration of the LIFE magazine. (Meally, Robert G., and Romare Bearden, 19) Kuhn in most of his time spent his summer in Fort Lee in New Jersey. This area provided him with a good environment for creativity which he needed to thrive in the industry. Kuhn would later join the New York School of art when they moved to the area as a member of the faculty. He later moved to New York where he got married to Vera Spier. They got one child Brenda Kuhn. At the point when his home life blossomed, his career too became better and better. In 1909, he spent the

Disability laws of the united states Essay Example | Topics and Well Written Essays - 1000 words

Disability laws of the united states - Essay Example To combat this lack of information, it is necessary to illuminate the incidence and prevalence of the disease to help educate the business owners about its impact on their own concerns. By enumerating the effectiveness of policies and programs that are currently in place as well as the laws and regulations requiring such programs, employers may be able to identify gaps and shortfalls in their current procedures. For many business owners, especially small business owners, the idea of adding one more responsibility to an already overflowing plate in terms of caring for employees seems a little daunting. However, studies conducted over the past 25 years regarding the spread of HIV and AIDS has proven that â€Å"where business, government and populations work together, the spread of HIV and AIDS can be slowed and infections reduced† (Roedy quoted in Bloom et al 2006). ... their workplace will be affected nor have those in less concerned countries, such as the United States, worked to establish formal policies within their organizations to address the issue. Even the small companies are required to follow some basic rules and guidelines drafted by the state to protect those with HIV and AIDS as well as to help prevent the spread of these illnesses among the greater population. All businesses are required to comply with state and federal civil rights laws that often apply to those suffering with HIV or the AIDS infections. These include Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990. â€Å"The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination against people with disabilities. Under the law, persons with HIV infection are entitled to the same rights and opportunities as persons with other communicable diseases† (Disabilities Act, 1992) In addition, employers are expected to make reasonable accommodations so that people with disabilities, including those with HIV/AIDS, are able to remain employed and productive for as long as they can possibly perform the essential functions of their jobs. This could include the assignment or reassignment of job duties, allowing employees to work at home on a temporary basis, allowing both paid and unpaid leaves of absences and accommodating a flexible work schedule. Jane Hodges (2004) indicates the ILO (International Labor Organization) recommendations to member states also include a ban on dismissal based on HIV/AIDS until the individual becomes medically unfit to carry out adapted work, a prohibition of non-consensual pre- and post-employment testing, legislation for the prevention and containment of transmission risks, training