Comparing Teens in Catcher in the Rye, Tears of a Tiger, and Whirligig :: comparison compare contrast essays

Problem Teens in Catcher in the Rye, Tears of a Tiger, and Whirligig The Catcher in the Rye, J.D. Salinger's novel set in the 1950s, told the story of sixteen-year-old Holden Caulfield. Deciding that he's had enough of Pencey, his fourth school that he'd failed, he goes to Manhattan three days before his scheduled return to home, not wanting to inform his parents that he'd been expelled and sent back. He explores the city, calls up some old friends, gets nicked by the elevator operator, and gradually becomes bitter about the world and people. He then visited his sister Phoebe. After fleeing from the house of Mr. Antolini, his former English teacher, because of mistaking his actions for a homosexual overture, Holden went to Phoebe's school and sent her a note telling her he was leaving home and to meet him at the museum. When Phoebe arrived, Holden angrily refused her request to take her with him and she ignored to speak to him. He then took her across the park to a carousel, bought her a ticket and watched her ride. Holden ended his narrat ive here, telling the reader that he was not going to tell the story of how he went home and got "sick". He planned to go to a new school in the fall and was cautiously optimistic about his future. Tears of a Tiger, Sharon M. Draper's compelling novel about the death of high school basketball star Rob Washington in an automobile accident, exposed the dangers of drinking and driving with its deadly consequences. Andy Jackson was driving the car that crashed, killing his best friend Rob, and the cost was more than he could bear. Months later, he still couldn't stop blaming himself, even after the constant comforts from his friends and sessions with a psychologist. Drowning in his guilt, he turned away from his family, his friends, his girlfriend and his future. Whirligig, Paul Fleischman's beautifully constructed novel that spun the complex story of Brent Bishop and his task to memorialize Lea, an unfortunate teen who crossed his path when he tried to kill himself in a car. To keep Lea's spirit alive, Brent was assigned to create four whirligigs that resembled Lea, and put them in the four corners of the United States.

Life of Quaid E Azam

ACCF/AHA Pocket Guideline Adapted from the 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy November 2011 Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons  © 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc.The following material was adapted from the 2011 ACCF/AHA Guidelines for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (J Am Coll Cardiol 2011;XX:XX–XX). This pocket guideline is available on the World Wide Web sites of the American College of Cardiology (www. cardiosource. org) and the American Heart Association (my. americanheart. org). For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail: [ema il  protected] com; phone: 212-633-3813; fax: 212-633-3820.Permissions: Multiple copies, modification, alteration, enhancement, and/ ordistribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at [email  protected] com. Contents 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 2. Clinical Definition †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦ 6 3. Genetic Testing Strategies/Family Screening †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 4. Genotype-Positive/Phenotype-Negative Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 5. Echocardiography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 10 6. Stress Testing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 14 7. Cardiac Magnetic Resonance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 15 8. Detection of Concomitant Coronary Disease †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 9. Asymptomatic Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 19 10.Pharmacologic Management†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 21 11. Invasive Therapies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 26 12. Pacing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 29 13. Sudden Cardiac Death Risk Stratification †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 30 14. Selection of Patients for Implantable Cardioverter-Defibrillators †¦ 32 15. Participation in Competitive or Recreational Sports and Physical Activity †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 16. Management of Atrial Fibrillation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 38 17. Pregnancy/Delivery †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 41 2 1. Introduction The impetus for the guidelines is based on an appreciation of the frequency of this clinical entity and a realization that many aspects of clinical management, including the use of diagnostic modalities, genetic testing, utilization of implantable cardioverter-defibrillators (ICDs), and therapies for refractory symptoms lack consensus.The discussion and recommendations about the various diagnostic modalities apply to patients with established HCM and to a variable extent to patients with a high index of suspicion of the disease. Classification of Recommendations The ACCF/AHA classifications of recommendations and levels of evidence are utilized, and described in more detail in Table 1. 3 Applying Classification of Recommendations and LevelRecommendations and Level of Evidence Table 1. Applying Classification of of Evidence Table 1. Applying Classification of Recommendations and Level of Evidence S i z e Class I Benefit >>> Risk f T r e a T m eSni T ee f ffe c T e a T z o Tr Class IIb Class IIa Benefit >>> Risk Benefit Risk Additional studies with broad Additional studies with objectives objectives needed focused needed; additional registryreasonable to perIt Is data would be helpful Class IIa Class I Benefit >> RiskRisk Benefit >>> Additional studies with Procedure/Treatment focused objectives needed should be performed/ Procedure/Treatment should be performed/ administered It administered Is reasonable to perform procedure/administer treatment n Recommendation favor n Recommendation in thatProcedure/Treatment form procedure/administer may be ConsIdered treatment n n Rec ommendation Recommendation’s eSTimaTe of cerTainTy (PreciSion) of TreaTmenT effecT a populations d* ived from multiple zed clinical trials analyses Recommendation that level a procedure or treatment Multiple populations is useful/effective evaluated* n Sufficient evidence from Data randomized multiple multiplederived from trials randomized clinical trials or meta-analyses or meta-analyses n of procedure or procedure treatment treatment is useful/effective being useful/effective n Sufficient evidence from n Some conflicting evidence n favor usefulness/efficacy less of treatment or procedure well established being useful/effective conflicting evidence evidence from multiple from multiple randomized randomized trials or trials or meta-analyses meta-analyses in favor of treatment or procedure usefulness/efficacy less being useful/effective well established conflicting evidence from single evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomi zed studies in favor usefulness/efficacy less of treatment or procedure well established being useful/effective opinion, case studies, or opinion, case studies, standard of care care or standard of may/might be considered is reasonable may/might be reasonable can be useful/effective/beneficial usefulness/effectiveness is is probably recommended unknown/unclear/uncertain or indicated or not well established n n Some Greater multiple randomized trials from multiple randomized or or meta-analyses trialsmeta-analyses b populations d* ived from a ndomized trial ndomized studiesRecommendation that level b procedure or treatment Limited populations is useful/effective evaluated* n Evidence from single Data derived or randomized trialfrom a single randomized trial nonrandomized studies or nonrandomized studies n n Recommendation in that n Recommendation favor n n Recommendation Recommendation’s of procedure or procedure treatment treatment being useful/effective is useful/effective n Some conflicting single n Evidence from n n Some Greater evidence from trial or randomized single randomized trial or nonrandomized studies nonrandomized studies n Recommendation favor n Recommendation in that C ited populations d* sensus opinion ts, case studies, ard of careRecommendation that level C procedure or treatment is Very limited populations useful/effective evaluated* n Only expert opinion, case Only consensus opinion studies, or standard of care of experts, case studies, or standard of care n n n Recommendation Recommendation’s of procedure or procedure is treatment treatment useful/effective being useful/effective n Only expert expert n Only divergingopinion, case studies, or studies, opinion, casestandard of care or standard of care is reasonable should can be useful/effective/beneficial is recommended is probably recommended is indicated oris useful/effective/beneficial indicated n n Only diverging expert Only diverging expert d phrases for commendations shou ld Suggested phrases for writing recommendations is recommended is ndicated is useful/effective/beneficial s treatment/strategy A is Comparative recommended/indicated in effectiveness phrases†  preference to treatment B treatment/strategy A is probably treatment/strategy A is recommended/indicated in in recommended/indicated preference to to treatment B preference treatment B it is reasonableshould be chosen treatment A to choose treatment A over treatment B over treatment B treatment/strategy A is probably recommended/indicated in preference to treatment B it is reasonable to choose treatment A over treatment B ive ess phrases†  4 treatment A should be chosen over treatment B e T menT e ffe c T A recommendation with Level of Evidence B or CClass IIIIIb Benefit Class No orBenefit > Risk Class III Harm Procedure/ Additional studies with broad test treatment objectives needed; additional Cor III: Not No Proven be helpful noregistry data would Benefit benefit Helpful Class II I No Benefit or Class III Harm Procedure/ test Cor III: Not no benefit Helpful Cor III: harm treatment No Proven Benefit does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. Procedure/Treatment Cor III: Excess Cost Harmful harm be w/o Benefit to Patients may ConsIdered or Harmful n n Recommendation’s Recommendation that Excess Cost Harmful w/o Benefit to Patients or Harmful Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. †  For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. n procedure or treatment is usefulness/efficacy less not useful/effective and may well established be harmful conflicting n Greater n evidence from multiple Sufficient evidence fromRecommendation that procedure or treatment is not useful/effective and may be harmful Sufficient evidence from multiple randomized trials or meta-analyses Recommendation that procedure or treatment is not useful/effective and may be harmful Evidence from single randomized trial or nonrandomized studies Recommendation that procedure or treatment is not useful/effective and may be harmful Only expert opinion, case studies, or standard of care COR III: Harm potentially harmful causes harm associated with excess morbidity/mortality should not be performed/ be done administered/ other n multiple randomizedor randomized trials trials or meta-analyses meta-analyses n n Recommendation’s Recommendatio n that n sefulness/efficacy less procedure or treatment is well established not useful/effective and may be harmful conflicting n Greater n evidence from single Evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomized studies n Recommendation’s Recommendation that usefulness/efficacy less procedure or treatment is well established not useful/effective and may n Only diverging expert be harmful opinion, case studies, or n Only expert opinion, case standard of care studies, or standard of care n n n n COR III: COR III: may/might be considered Nomay/might be reasonable Benefit Harm usefulness/effectiveness is is not potentially unknown/unclear/uncertain recommended harmful or indicated not well established harm is not causes associated with excess morbidity/mortality should not be done COR III: No Benefit is not recommended is not indicated should not be performed/ be done administered/ is not useful/ other beneficial/ is not useful/ effect ive bene? cial/ effective should not be done s not useful/ beneficial/ effective 5 2. Clinical Definition The generally accepted definition of hypertrophic cardiomyopathy (HCM), is a disease state characterized by unexplained left ventricular (LV) hypertrophy associated with nondilated ventricular chambers in the absence of another cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident in a given patient. Clinically, HCM is usually recognized by maximal LV wall thickness ? 15 mm, with wall thickness of 13 to 14 mm considered borderline, particularly in the presence of other compelling information (e. g. , family history of HCM), based on echocardiography.In terms of LV wall-thickness measurements, the literature has been largely focused on echocardiography, although cardiovascular magnetic resonance (CMR) is now used with increasing frequency in HCM. In the case of children, increased LV wall thickness is defined as wall thickness ? 2 standard deviations above the mean (z score ? 2) for age, sex, or body size. However, it should be underscored that in principle, any degree of wall thickness is compatible with the presence of the HCM genetic substrate and that an emerging subgroup within the broad clinical spectrum is composed of family members with disease-causing sarcomere mutations but without evidence of the disease phenotype (i. e. , LV hypertrophy). 6 3. Genetic Testing Strategies/Family Screening Class I 1.Evaluation of familial inheritance and genetic counseling is recommended as part of the assessment of patients with HCM. (Level of Evidence: B) 2. Patients who undergo genetic testing should also undergo counseling by someone knowledgeable in the genetics of cardiovascular disease so that results and their clinical significance can be appropriately reviewed with the patient. (Level of Evidence: B) 3. Screening (clinical, with or without genetic testing) is recommended in first-degree relatives of pati ents with HCM. (Level of Evidence: B) 4. Genetic testing for HCM and other genetic causes of unexplained cardiac hypertrophy is recommended in patients with an typical clinical presentation of HCM or when another genetic condition is suspected to be the cause. (Level of Evidence: B) 7 Class IIa 1. Genetic testing is reasonable in the index patient to facilitate the identification of first-degree family members at risk for developing HCM. (Level of Evidence: B) Class IIb 1. The usefulness of genetic testing in the assessment of risk of sudden cardiac death (SCD) in HCM is uncertain. (Level of Evidence: B) Class III: 1. Genetic testing is not indicated in relatives when pathogenic mutation. (Level of Evidence: B) 2. Ongoing clinical screening is not indicated in genotype-negative relatives in families with HCM. Level of Evidence: B) No Benefit the index patient does not have a definitive 8 4. Genotype-Positive/Phenotype-Negative Patients Class I 1. In individuals with pathogenic mutat ions who do not express the HCM phenotype, it is recommended to perform serial electrocardiogram, transthoracic echocardiogram (TTE), and clinical assessment at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status. (Level of Evidence: B) 9 5. Echocardiography Class I 1. A TTE is recommended in the initial evaluation of all patients with suspected HCM. (Level of Evidence: B) 2.A TTE is recommended as a component of the screening algorithm for family members of patients with HCM unless the family member is genotype negative in a family with known definitive mutations. (Level of Evidence: B) 3. Periodic (12 to 18 months) TTE screening is recommended for children of patients with HCM, starting by age 12 or earlier if a growth spurt or signs of puberty are evident and/or when there are plans for engaging in intense competitive sports or there is a family history of SCD. (Level o f Evidence: C) 4. Repeat TTE is recommended for the evaluation of patients with HCM with a change in clinical status or new cardiovascular event. (Level of Evidence: B) 5. A transesophageal echocardiogram (TEE) is recommended for the intraoperative guidance of surgical myectomy. (Level of Evidence: B) 10 6.TTE or TEE with intracoronary contrast injection of the candidate’s septal perforator(s) is recommended for the intraprocedural guidance of alcohol septal ablation. (Level of Evidence: B) 7. TTE should be used to evaluate the effects of surgical myectomy or alcohol septal ablation for obstructive HCM. (Level of Evidence: C) Class IIa 1. TTE studies performed every 1 to 2 years can be useful in the serial evaluation of symptomatically stable patients with HCM to assess the degree of myocardial hypertrophy, dynamic obstruction, and myocardial function. (Level of Evidence: C) 2. Exercise TTE can be useful in the detection and quantification of dynamic left ventricular outflow tract (LVOT) obstruction in the absence of resting outflow tract obstruction in patients with HCM. (Level of Evidence: B) 11 3.TEE can be useful if TTE is inconclusive for clinical decision making about medical therapy and in situations such as planning for myectomy, exclusion of subaortic membrane or mitral regurgitation secondary to structural abnormalities of the mitral valve apparatus, or in assessment for the feasibility of alcohol septal ablation. (Level of Evidence: C) 4. TTE combined with the injection of an intravenous contrast agent is reasonable if the diagnosis of apical HCM or apical infarction or severity of hypertrophy is in doubt, particularly when other imaging modalities such as CMR are not readily available, not diagnostic, or contraindicated. (Level of Evidence: C) 5.Serial TTE studies are reasonable for clinically unaffected patients who have a first-degree relative with HCM when genetic status is unknown. Such follow-up may be considered every 12 to 18 months f or children or adolescents from high-risk families and every 5 years for adult family members. (Level of Evidence: C) 12 Class III: 1. TTE studies should not be performed more HCM when it is unlikely that any changes have occurred that would have an impact on clinical decision making. (Level of Evidence: C) 2. Routine TEE and/or contrast echocardiography is not recommended when TTE images are diagnostic of HCM and/or there is no suspicion of fixed obstruction or intrinsic mitral valve pathology. (Level of Evidence: C)No Benefit frequently than every 12 months in patients with 13 6. Stress Testing Class IIa 1. Treadmill exercise testing is reasonable to determine functional capacity and response to therapy in patients with HCM. (Level of Evidence: C) 2. Treadmill testing with monitoring of an electrocardiogram and blood pressure is reasonable for SCD risk stratification in patients with HCM. (Level of Evidence: B) 3. In patients with HCM who do not have a resting peak instantaneous g radient of greater than or equal to 50 mm Hg, exercise echocardiography is reasonable for the detection and quantification of exercise-induced dynamic LVOT obstruction. (Level of Evidence: B) 14 7. Cardiac Magnetic Resonance Class I 1.CMR imaging is indicated in patients with suspected HCM when echocardiography is inconclusive for diagnosis. (Level of Evidence: B) 2. CMR imaging is indicated in patients with known HCM when additional information that may have an impact on management or decision making regarding invasive management, such as magnitude and distribution of hypertrophy or anatomy of the mitral valve apparatus or papillary muscles, is not adequately defined with echocardiography. (Level of Evidence: B) Class IIa 1. CMR imaging is reasonable in patients with HCM to define apical hypertrophy and/or aneurysm if echocardiography is inconclusive. (Level of Evidence: B) 15 Class IIb 1.In selected patients with known HCM, when SCD risk stratification is inconclusive after docume ntation of the conventional risk factors, CMR imaging with assessment of late gadolinium enhancement may be considered in resolving clinical decision making. (Level of Evidence: C) 2. CMR imaging may be considered in patients with LV hypertrophy and the suspicion of alternative diagnoses to HCM, including cardiac amyloidosis, Fabry disease, and genetic phenocopies such as LAMP2 cardiomyopathy. (Level of Evidence: C) 16 8. Detection of Concomitant Coronary Disease Class I 1. Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with HCM with chest discomfort who have an intermediate to high likelihood of coronary artery disease (CAD) when the identification of concomitant CAD will change management strategies. (Level of Evidence: C) Class IIa 1.Assessment of coronary anatomy with computed tomographic angiography is reasonable for patients with HCM with chest discomfort and a low likelihood of CAD to assess for possible concomitant CAD. (Level of E vidence: C) 2. Assessment of ischemia or perfusion abnormalities suggestive of CAD with single-photon emission computed tomography or positron emission tomography myocardial perfusion imaging (because of excellent negative predictive value) is reasonable in patients with HCM with chest discomfort and a low likelihood of CAD to rule out possible concomitant CAD. (Level of Evidence: C) 17 Class III: 1. Routine single-photon emission computed echocardiography is not indicated for detection of â€Å"silent† CAD-related ischemia in patients with HCM who are asymptomatic. (Level of Evidence: C) 2.Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by positron emission tomography is not indicated for the assessment of prognosis in patients with HCM. (Level of Evidence: C) No Benefit tomography myocardial perfussion imaging or stress 18 9. Asymptomatic Patients Class I 1. For patients with HCM, it is recom mended that comorbidities that may contribute to cardiovascular disease (e. g. , hypertension, diabetes, hyperlipidemia, obesity) be treated in compliance with relevant existing guidelines. (Level of Evidence: C) Class IIa 1. Low-intensity aerobic exercise is reasonable as part of a healthy lifestyle for patients with HCM. (Level of Evidence: C) Class IIb 1.The usefulness of beta blockade and calcium channel blockers to alter clinical outcome is not well established for the management of asymptomatic patients with HCM with or without obstruction. (Level of Evidence: C) Class III: Harm 1. Septal reduction therapy should not be performed for asymptomatic adult and pediatric patients with HCM with normal effort tolerance regardless of the severity of obstruction. (Level of Evidence: C) 2. In patients with HCM with resting or provocable outflow tract obstruction, regardless of symptom status, pure vasodilators and high-dose diuretics are potentially harmful. (Level of Evidence: C) 19 Fi gure 1. Treatment Algorithm HCM PatientsACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; DM, diabetes mellitus; EF, ejection fraction; GL, guidelines; HCM, hypertrophic cardiomyopathy; HTN, hypertension; and LV, left ventricular. Treat comorbidities according to GL [HTN, Lipids, DM] Obstructive Physiology No Heart Failure Symptoms or Angina No Yes Yes Avoid vasodilator therapy and highdose diuretics Systolic Function Annual clinical evaluation No Heart Failure Symptoms or Angina LV EF 50 mm Hg) for whom standard medical therapy has failed. (Level of Evidence: C) 4.When surgery is contraindicated or the risk is considered unacceptable because of serious comorbidities or advanced age, alcohol septal ablation, when performed in experienced centers, can be beneficial in eligible adult patients with HCM with LVOT obstruction and severe drug-refractory symptoms (usually New York Heart Association functional classes III or IV). (Level of Evidence: B) 26 Class IIb 1. Alcohol septal ablation, when performed in experienced centers, may be considered as an alternative to surgical myectomy for eligible adult patients with HCM with severe drug-refractory symptoms and LVOT obstruction when, after a balanced and thorough discussion, the patient expresses a preference for septal ablation. (Level of Evidence: B) 2. The effectiveness of alcohol septal ablation is uncertain in patients with HCM with marked (i. e. , >30 mm) septal hypertrophy, and therefore the procedure is generally discouraged in such patients. (Level of Evidence: C) Class III: Harm 1.Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. (Level of Evidence: C) 2. Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. (Level of Evidence : C) 27 3. Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. (Level of Evidence: C) 4. Alcohol septal ablation should not be done in patients with HCM with concomitant disease that independently warrants surgical correction (e. g. coronary artery bypass grafting for CAD, mitral valve repair for ruptured chordae) in whom surgical myectomy can be performed as part of the operation. (Level of Evidence: C) 5. Alcohol septal ablation should not be done in patients with HCM who are less than 21 years of age and is discouraged in adults less than 40 years of age if myectomy is a viable option. (Level of Evidence: C) 28 12. Pacing Class IIa 1. In patients with HCM who have had a dualchamber device implanted for non-HCM indications, it is reasonable to consider a trial of dual-chamber atrial-ventricular pacing (from the right ventricular apex) for the relief of symptoms attributable to LVOT obst ruction. (Level of Evidence: B) Class IIb 1.Permanent pacing may be considered in medically refractory symptomatic patients with obstructive HCM who are suboptimal candidates for septal reduction therapy. (Level of Evidence: B) Class III: 1. Permanent pacemaker implantation for the performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled. (Level of Evidence: C) 2. Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction in patients who are candidates for septal reduction. (Level of Evidence: B) No Benefit purpose of reducing gradient should not be 29 13. Sudden Cardiac Death Risk Stratification Class I 1.All patients with HCM should undergo comprehensive SCD risk stratification at initial evaluation to determine the presence of: (Level of Evidence: B) a. A personal history for ventricular fibrillation, sustained ventricular tach ycardia, or SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * b. A family history for SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * c. Unexplained syncope. d. Documented nonsustained ventricular tachycardia (NSVT) defined as 3 or more beats at greater than or equal to120 bpm on ambulatory (Holter) electrocardiogram. e. Maximal LV wall thickness greater than or equal to 30 mm. Appropriate ICD discharge is defined as ICD therapy triggered by VT or ventricular fibrillation, documented by stored intracardiac electrogram or cycle-length data, in conjunction with the patient’s symptoms immediately before and after device discharge. 30 Class IIa 1. It is reasonable to assess blood pressure response during exercise as part of SCD risk stratification in patients with HCM. (Level of Evidence: B) 2. SCD risk stratification is reasonable on a periodic basis (every 12 to 24 months) for patients with HCM who have not under gone ICD implantation but would otherwise be eligible in the event that risk factors are identified (12 to 24 months). (Level of Evidence: C)Class IIb 1. The usefulness of the following potential SCD risk modifiers is unclear but might be considered in selected patients with HCM for whom risk remains borderline after documentation of conventional risk factors: a. CMR imaging with late gadolinium enhacement. (Level of Evidence: C) b. Double and compound mutations (i. e. , >1). (Level of Evidence: C) c. Marked LVOT obstruction. (Level of Evidence: B) Class III: Harm 1. Invasive electrophysiologic testing as routine SCD risk stratification in patients with HCM should not be performed. (Level of Evidence: C) 31 14. Selection of Patients for Implantable Cardioverter-Defibrillators Class I 1.The decision to place an ICD in patients with HCM should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient’s active participation in decision making. (Level of Evidence: C) 2. ICD placement is recommended for patients with HCM with prior documented cardiac arrest, ventricular fibrillation, or hemodynamically significant ventricular tachycardia. (Level of Evidence: B) Class IIa 1. It is reasonable to recommend an ICD for patients with HCM with: a. Sudden death presumably caused by HCM in 1 or more first-degree relatives. (Level of Evidence: C) b. A maximum LV wall thickness greater than or equal to 30 mm. (Level of Evidence: C) c. One or more recent, unexplained syncopal episodes. (Level of Evidence: C) 2.An ICD can be useful in select patients with NSVT (particularly those 30 mm or Recent unexplained syncope No Yes ICD reasonable Nonsustained VT or Abnormal BP response Yes Other SCD Risk Modifiers* Present? Yes No ICD can be useful Legend Class I Class IIa No ICD not recommended Class IIb Class III Role of ICD uncertainRegardless of the level of recommendatio n put forth in these guidelines, the decision for placement of an ICD must involve prudent application of individual clinical judgment, thorough discussions of the strength of evidence, the benefits, and the risks (including but not limited to inappropriate discharges, lead and procedural complications) to allow active participation of the fully informed patient in ultimate decision making. BP indicates blood pressure; ICD, implantable cardioverter-defibrillator; LV, left ventricular; SCD, sudden cardiac death; SD, sudden death; and VT, ventricular tachycardia. 35 15. Participation in Competitive or Recreational Sports and Physical ActivityClass IIa 1. It is reasonable for patients with HCM to participate in low-intensity competitive sports (e. g. , golf and bowling). (Level of Evidence: C) 2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities as outlined in Table 2. (Level of Evidence: C) Class III: Harm 1. Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverterdefibrillator for high-risk status. (Level of Evidence: C) 36 Table 2. Recommendations for the Acceptability of Recreational Noncompetitive) Sports Activities and Exercise in Patients With HCM* Intensity Level High Basketball (full court) Basketball (half court) Body building†¡ Gymnastics Ice hockey†¡ Racquetball/squash Rock climbing†¡ Running (sprinting) Skiing Soccer Tennis (singles) Touch (flag) football Windsurfing § Moderate Baseball/softball Biking Modest hiking Motorcycling†¡ Jogging Sailing § Surfing § Swimming (laps) § Tennis (doubles) Treadmill/stationary bicycle Weightlifting (free weights)†¡|| Hiking 2 4 4 3 3 3 2 5 4 5 1 3 (downhill)†¡ Skiing (cross-country) 0 0 1 2 0 0 1 0 2 2 0 0 1 1 Eligibility Scale for HCM†  Intensity Level Low Bowling Golf Hor seback riding†¡ Scuba diving § Skating ¶ Snorkeling § Weights (nonfree weights) Brisk walking 5 5 3 0 5 5 4 5 Eligibility Scale for HCM†  *Recreational sports are categorized according to high, moderate, and low levels of exercise and graded on a relative scale (from 0 to 5) for eligibility, with 0 to 1 indicating generally not advised or strongly discouraged; 4 to 5, probably permitted; and 2 to 3, intermediate and to be assessed clinically on an individual basis. The designations of high, moderate, and low levels of exercise are equivalent to an estimated >6, 4 to 6, and

Approximately One Out Of Every Seven People Entering The

Approximately one out of every seven people entering the hospital needs blood. Whether it is due to a pre-existing condition, an emergency accident, or an upcoming surgery, blood is a key component to the success of many procedures. Without donations, it would be impossible to complete many life-saving tasks, since there is no substitute for blood. Donating blood is an easy yet significant act, so anyone who is able should donate blood, since blood donations make a world of difference in many people’s lives. Blood donation is the voluntary process of having one’s own blood drawn and then transferred to another in need of the blood (Mayo). There are many instances that call for the need of blood. Whether it is severe trauma, childbirth†¦show more content†¦Consequently, hospitals cannot keep the shelves stocked since there is a lack in donating from eligible donors. Although about 40% of Americans are eligible to donate, â€Å"less than 10% actually donate† (Donate Blood). There is an increasing shortage of blood supply due to lack of donations, as well as the fact that â€Å"40,000 pints of blood are used each day in the United States† (Donate Blood). A significant factor in the lack of donations is the negative perception on the part of donors. Due to the constant need for blood, testing and screening have advanced so as to reduce risks to a donor. Many precautions are taken to ensure safety and to prevent any issues from arising, thus donating is safe for everyone. There are height and weight requirements for donors. Similarly, before the donation begins, an in-depth medical history interview takes place. It is necessary for the safety of the donor and recipient for the blood to be tested prior to donating. Also, iron levels are tested to ensure the donor will recover quickly and efficiently. Materials used while gathering blood are sterile and only used once (General Donation Facts). Preventing disease transmission has been made possible through â€Å"great improvements of donor security screening and the use of a variety of tests† (Center for Biologics†¦). Another aspect of safety is the â€Å"handling and distribution of blood† (Center for Biologics†¦), which must follow rules and guidelines to e nsure noShow MoreRelatedOn January 2017 The New President Of The United States1287 Words   |  6 Pagesborn in one of the following seven Middle Eastern countries: Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen, specifically Muslims and Syrians. According to what President Trump was saying, this order is made for the safety of the country, and to limit what is called the â€Å"Foreign Terrorism† inside the United States. People who agree with this law believe that banning believers of a specific faith and refugees entering the United State will make them safer. 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Maintaining self-respect should be thought of in the decision making process.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  We all face decisions in every day life, some appearRead MoreVideo Games And Its Effect On Society1171 Words   |  5 Pagesthe culture based on tastes of ordinary people rather than an educated elite. Pop culture should be taught in schools. By teaching pop culture to students, it will help them know what’s going on in the world and helps them pay more attention in class. There are different types of pop culture such as, entertainment, music, video games, and sports. Teaching pop culture can benefit any classroom. Pop culture began after the Industrial Revolution, when the people had more free time and they wanted more

Othello - 1519 Words

Michael Chica 209 Trull February 15th, 2013 English 1302 01 Professor Beavers A Man’s Dream In the poems written by Alfred, Lord Tennyson’s â€Å"Ulysses† and â€Å"Odysseus† written by W.S. Merwin we can compare and contrast both poems. In Tennyson’s â€Å"Ulysses† and in Merwin’s â€Å"Odysseus† they are talking about the same person, Odysseus. But the poems are also different because, Tennyson’s poem is about Odysseus talking about how his son would be a better fit king than he was, and that he would rather sail to find another world. In Merwin’s poem Odysseus talks about his journeys from one island to the other and how he is still sailing and trying to get home. So how can we compare and contrast both poems? Easy, because one poem is†¦show more content†¦Another example is when Odysseus landed on the island ruled by Poseidon’s son, Polyphemus. Odysseus and his crew were traveling the island when they came face to face with the Cyclops; the Cyclops then grabbed all of them and brought them t o his home as prisoners. This shows that Odysseus really did not want to go home. If he did then he would have not fallen into the traps set by Poseidon. Instead the God of Water got the best of Odysseus and targeted his weak points, his weak points of traveling and also seductive women. By having these distractions in Odysseus’s way he almost lost the love of his life, his own flesh and blood Telemachus, and also the kingdom of Ithaca. In the poem â€Å"Ulysses† written by Alfred, Lord Tennyson, Odysseus says â€Å"Though much is taken, much abides; and though We are not now that strength which in old days Moved earth and heaven, that which we are, we are One equal temper of heroic hearts, made weak by time and fate but strong in will To strive, to see, to find and not to yield.† And in the poem â€Å"Odysseus† written by W.S. Merwin it says â€Å"The knowledge of all that he betrayed Grew till it was the same whether he stayed or went. Therefore he wen t. And what wonder If sometimes he could not remember Which was the one who wished on his departure Perils that he could never sail through, And which, improbable, remote, and true, Was the one he kept sailing home to?† As we can tell in the poem â€Å"Ulysses†, OdysseusShow MoreRelatedOthello And Othello By William Shakespeare Essay1304 Words   |  6 PagesDesdemona?† they ask. The differences that separate Othello and Desdemona do not perturb them, but are starkly obvious and unnerving to the judgmental citizens of Venice. While it was certainly rare in the 16th century for couples to have such disparities in age, social position and race, none of these differences diminished how Othello and Desdemona felt for each other, yet each spurred external obstacles that threatened their relationship. 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Othello becomes more aware of what Iago is saying and the anger that he has towards Iago has significantly reduced, while he begins to doubt Desdemona.Read More Free Othello Essay: The Disintegration of Othello590 Words   |  3 PagesDisintegration of Othello nbsp; nbsp;nbsp; Shakespeares Othello is a play with unique characters. One such character is the one for which Shakespeare names his play. In the play, Othello disintegrates from a confident leader to a homicidal murderer. Linguistic changes throughout the play attest to this theory. nbsp; In the opening scenes, Shakespeare portrays Othello as a noble character. When Brabantio seeks vengeance (for stealing his daughter) on Othello, Othello expresses his actions

Maternal Depression On Child Wellbeing And Development

Introduction During the last two decades, researchers have intensified their efforts to expand the findings about paternal perinatal depression. The study conducted by Goodman in 2004, has shown that the postpartum depression’s prevalence among fathers varied from 1.2% to 25% in the population sample. Furthermore, these percentages rose to achieve 24 to 50 per cent when the paternal postpartum depression was associated with maternal postpartum depression. The literature review and studies asserted the detrimental consequences of paternal perinatal depression on child wellbeing and development (Children, C. on D., Parenting Practices, and the Heaslthy Development of, Medicine, I. of, Education, D. of B. and S. S. and, Council, N. R., 2009) such as hyperactivity, emotional deregulations, behavioral problems (Davis, Davis, Freed, Clark, 2011, van den Berg et al., 2009). These studies outlined the importance of prevention and intervention to foster the paternal perinatal depression issue, th rough developing screening, diagnosis and management guidelines. However, research has shown that men are less likely than women to seek-help for mental health problems, including depression, anxiety, mood disorders and emotional difficulties (PadeskyHammen, 1981; Australian Bureau of Statistics, 2007). The Australian Bureau of Statistics in 2007 has reported that â€Å"at some point in their lives one in five men experience anxiety and one in eight will have depression, whereas for women oneShow MoreRelatedFactors That Affect Maternal Mental Health Essay1094 Words   |  5 Pagesaspect of maternal mental health. Among those mentionable factors social factor is a significant aspect. On the basis of the collected data it has been observed that, women disadvantaged social background is prone and exposed to maternal mental illness. The reason being the fact that, the social background acts as a, constrain on their part in terms of awareness and availing required care services and assistance in such condition. As result of this the symptoms associa ted with maternal mental illnessRead MoreRacism And The Australian Human Rights Commission1626 Words   |  7 Pagesyear. Racism can also affect physical health, life expectancy, and social cohesion. Evidence suggests that discrimination and racism are linked to a range of adverse health conditions, including poor mental health and wellbeing in children aged 1 to 15 years (Mitchell, 2014). Maternal race is one of the most analysed, robust, and puzzling findings in the epidemiology of prematurity. It is believed that African-American women are two to three times more likely than white women to deliver preterm andRead MoreMaternal Depression : A Standard ( New York State Department Of Health1048 Words   |  5 PagesDespite widespread recognition of the problem of maternal depression and the potential benefits of screening, screening for maternal depression is not a standard (New York State Department Of Health, 2016). This policy brief was written for healthcare providers who treat expectant and new mothers with goals to improve the screening and to increase the number of women receiving appropriate treatment in our community. The recommendations address measures to improve early identification of the conditionRead MoreEffects Of Mental Illness And Stigma On Pregnant Women Essay2225 Words   |  9 Pagesassociated with the pregnancy of women and their mental health that has brought this topic to the forefront is the fact that mental health problems like depression and anxiety have the probability to impact women twice as compared to men. The severity of the situation can be seen from the fact that depression is one of the main reasons of maternal mental illness during the childbearing age of women, which is approximately between the age group of 15 to 44 years. As a result of this to the Global BurdenRead MoreThe s Nursing Theory : Maternal Role Attainment1321 Words   |  6 PagesTheory: Maternal Role Attainment Tiffany A. Walter Benedictine University Ramona T. Mercer’s Nursing Theory: Maternal Role Attainment Ramona Mercer is a well-known nursing theorist who specializes in nursing of the mother and child. Ramona Mercer developed a theory that helps a mother bond with her child/children. This theory is called the Maternal Role Attainment Theory. Bonding between a mother and her child is very important in the development and growth of the child. RamonaRead MoreAssessment Of Maternal Mental Health Essay2039 Words   |  9 PagesAssessment 1- Maternal mental health in women aged 18-40 in Tower Hamlets Borough â€Æ' Table of Contents Title 2 Introduction 2 Background 2 Rationale 3 Data Collection 4 Secondary Data 4 Analysis 6 Intervention 7 Conclusion 8 References 9 â€Æ' Title Maternal mental health in women age 18-40 in Tower Hamlets Borough Introduction In terms of public health and associated concern, in the recent years it has been observed that mental illness has major impact on pregnant women and postpartum period whichRead MoreChild Infant Interaction During The First Year Of Life1197 Words   |  5 Pages Longitudinal Development of Mother- Infant Interaction During the First Year of Life Among Mother with Substance Abuse and Psychiatric Problems and Their Infants Mauricio Sampogna Lone Star College – University Park Dr. Cherry H. 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(2) The effect of receiving sufficient nutrientsRead MoreA Community Mental Health Team822 Words   |  4 Pageswith a community mental health team in the Northeast of England I came across a lady in her mid-twenties who had just recently gave birth to a child. My mentor and I had to go and assess her due to her showing symptoms of postnatal depression, it was important to assess the safety of her and her new-born child and to see if she was able to care for the child. 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Cycle Assessment of Die Cast Model Car Life

Question: Conduct a Qualitative life Cycle Assessment (LCA) of a Product with the view of promoting a general understanding of the Environmental Impact of the product from Manufacture through use and Disposal. Answer: Introduction Manufacturing normally focus on the cost and the products quality leaving behind the environmental issue which is regarded as the last option to comply to the regulation of the environment. The environmental performance of the die-cast car model is investigated by the implementation of a life circle assessment. The concern of the environment about the product is becoming a driving force in the activities of the business. One of the major roles LCA is to collect the inventory data of the life circle for a four ground system so as to introduce thinking of the stage of the design product with the scoring system of the environment that are based on the computer. LCA also identify the key parts in the life circle of the product for the improvement of the products performance environmentally.(Ann, 2015, p. 152) To develop the products that are friendly to be the environment, Life Cycle assessment should be implemented first. The product designer can get the guidance from the study of the Life Cycle Assessments output which improves the products performance environmentally so as to help the decision maker in making a long and short term goals. This essay is a review of the LCA task of a die cast model car. Die-casting is a process that produces a metal part that is complex through the usage of reusable moulds. It involves the use of metals, a die and a die-casting machine. In both machines, after the dice are injected, it cools and then solidifies into the final product. It typically makes use of the alloys that are non-ferrous, like in this project we are to use Aluminum alloy which has relatively high dimension stability, easy to cast, density is low and also its ability to resist its corrosion. (B, 2002, p. 96) The main scope of this study is to come up with the life circle assessment of a die-cast model car that will improve its environmental performance. At the time of LCA, the goals of the learning unravels that one has to assemble life cycle inventory data used in die-cast model cars. The qualitative life cycle assessment of a die-cast model car should be conducted, keeping in view the environmental impact of the product from the process of manufacturing and usage. The ensemble outcome from the study is a prelude to the environmental sustainability of the die-cast model cars. (BUWAL, 2001, p. 251) Product and Functional Unit A die-cast model car is produced by using the die-casting method. The car is comprised of plastic, rubber and elaborates glass work by following the process of injection molding. The metals used are aluminum and poly (methyl methacrylate). The functional unit of a die-cast model car can be described as new 1:18 level die-cast car model of Porche Cayman GT4 Racing Yellow die cast car. It entails completely new features and comprises rubber tires. The model die-cast car contains steer-enabled wheels. The model car is made of die-casting, along with some plastic materials. The life span of a die-cast car model can be more than three years of functionality and the components for service can be kept in the company for the whole of that functionality period of the die-cast car model. (2015, p. 190) Table 1: Material and components involved in the manufg oacturing of die-cast model car Component Melting point Atomic mass Aluminum 660 degree Celsius 26.981539 u + 8*10^7 u Poly (methyl methacrylate) 160 degree Celsius Fluctuates System boundary and Data Collection The model of Porche Cayman GT4 Racing Yellow die cast car contains all materials that are maintained in the inventory analysis. Due to certain precarious issues, the data deficiencies are left. Despite data dearth, the process data that is similar to the authentic process is utilized with ease.(Koop, 2002, p. 147) The collection of data process consumes time and also tiring. The cycle of the life process is grouped as foreground and background system that reinforces the mechanism of statistics collection in the study. In order to start the background system, we have utilized secondary data, without assembling data from the existing sites. For instance, commercial data indices are kept under the category of production of raw material mechanism and process of energy. In the process of foreground, we have assembled resources from the particular sites used in every process of the experiment. At the same time, we have concluded the process by deliberating on the questionnaire survey.(H, 2011, p. 86) The extraction of raw resources, the production of experiment staffs and the building of energy are conclusively categorized as the background system, in as much the builders of these products are categorized as homogenous unit. The system of gathering data from the primary sites used within the ambit of the company is known as foreground method of data collection. The waste management process falls under the category of the foreground method.(G, 2003, p. 160) This table shows the foreground ad background and their properties mechanism and properties Life cycle phase Mechanism Properties Extraction of raw materials Background Secondary data Production of energy Background Secondary data Production of material Background Secondary data Production of components Foreground Site-based data Process of gathering a die-cast model car Foreground Site-based data Usage Foreground Assumption Management of waste Foreground Secondary data Scenario and Allocation The burdens of environment in most cases are waste generation and releasing of the emission, which are needed to be allocated to the die-cast car model. The products quantity and its physical properties are chosen to be used as the factors of allocation for the environmental burden depending on the characteristics of the processes. The process in which the products quantity is taken as the factor of allocation is a procedure that the die-cast car model produces burdens of the environment. For a process like management of waste, the allocation done is grouped on the cause effect analysis. After the deliverance of die-cast car model, the materials that have been used for packaging are returned by the retailers or they can be disposed by the consumers. For the materials packaging, the polystyrene is recycled, but packaging materials that are small like Aluminum and Polyethylene bags are buried under the ground and incinerated respectively,(Johnson, 2001, p. 180) Inventory Analysis When the data are collected from the supplier, the emissions, melting point and the balance of mass in the model are then checked by the practitioner of Life Cycle Assessment and an expert within the company. When a data is strange or missing, then the questioner containing statistics is returned to the supplier to verify and find the data missing data. When the supplier lack adequate data then the Life Cycle Assessment practitioner treats the data missing based on the materials composition. The emission from battery cell which is the source of power for the model is calculated based on power grid from Korea. (Ekologik, 2006, p. 142) The calculations of the inventory are done by Life Cycle Assessment commercial software. The impact categories of the die-cast motor car that are used in this study are: Toxicity of the ecology, toxicity of human, global warming, eutrophication, acidification, abiotic resource depletion, formation of photochemical oxidant, depletion of the ozone layer. In these impact categories, their weighing and normalization are done to enable communication with the people who designed the model and the company. The factor of weighing for the impact categories are gotten from the internal or external expects selected from different parties after a survey. Fig. Abiotic resource consumption in life circle of die-cast model car. Fig 2. Environmental emission in life cycle of a die-cast model car Many parameters of the environment are present in the inventory analysis and only are present to represent the other parameters because it is not impossible to show many parameters of the environment. The phase of production largely contributes to the use of Aluminum and Methyl methacrylate because of the being the main material used in die-cast car model. It is not easy to find out the hot spot in the die-cast car model life circle and even the designers of the model find it difficult in understanding the inventory analysis results. But the outcomes of the inventory should be taken serious because it is important in making the in-house database.(Mcgimsey, 2000, p. 185) Impact Analysis Fig3. 8 impacts categories for the dye-cast car model Some resources like water and biotic are not included in the assessment impact because as for the biotic resource they are known as a fund and not a deposit and water is a flow. The abiotic resource calculation of the depletion is made from a method known as reserve base that is majorly concerned with the concentration of the crust of the earth. The production phase is the major contributor to the abiotic resource depletion. Aluminum is the burden of the environment in the abiotic resource depletion in the manufacture of die-cast model car. The impacts of global warming include the gasses effect that is direct with the time of 95 years. Carbon (IV) oxide is the main burden if the environment, that is released from the consumption of the energy. The global warming is contributed by the operating mode by over 50% , the main contributor of the global warming happens during plastic assembly process in which the majority of the greenhouse gases re released into the atmosphere. Hydrocarbon is contributing to the burden in the environment through photochemical formation oxidant. Acidification is caused by SOx, which is very serious environmental burden while eutrophication is also caused by another burden to the environment called NOx . These two environmental burdens are also related to energy negatively. During operating mode, it is when acidification and eutrophication is contributed largely into the atmosphere. (2015, p. 201) The main contributor to both ecological and human toxicity is SOx . The operating mode is important to potential impact but not in the abiotic resource depletion, for any impact category, total solution is important for the product designer for the performance of the environment by making a priority between the hot spot in activities improvement hence the potential impact weights are put into consideration. Results of Weighting The fig. 4 below presents the ration of contribution for each process. It is based on the weighing results, the phases are divided into two: energy saving and operating mode. Energy saving mode contribute to a percentage of 10% and the contribution of operating mode is 60%. Since the two modes depends on the duration of time and also difference in the requirement of energy it is good to estimate the different patterns of scenarios sad their effect and the reliability of the results. The following were the scenarios that were considered. Fig.4 Way 1: Energy mode: 1hr per day and operating mode: 2hr per day Way2: Energy saving mode 1.5hr per day and operating mode 3hr per day Way 3: Energy saving mode 4hr per day and operating mode 2hr per day Way4: Energy saving mode 3hr per day and operating mode 3hr per day Way 5: Energy saving mode 3 hrs per day and operating mode is 7hr per day Way 6: Energy saving mode is 7 hrs per day and operating mode is 9hr per day Fig 5.The analyzed results o the sensitivity and the ways of pattern used Packaging box and material packaging contribute to all the performance of the environment of the die-cast model car for the reduction of the materials amount and improvement of the performance of the environment then a better design is recommended. The process of managing the waste benefits the environment because the material used in designing the die-cast car model can be reused and recycled. More work to collect the data specific which improves the performance of the environment of a die-cast car model at the stage of waste management is required. The injection of plastic which is done by the manufactures into the mold assists in creation of the light weight and lower cost die-cast car model.(Muthu, 2002, p. 104) The life cycle assessment sensitivity studies comes from the boundary of systems, sources of data, methods of allocation and methods of assessing the impacts. As for the system background, secondary data are used for sources of data while for the system fore-ground, there is collection of specific data. When comparing the sensitivity between different systems, it arises more in the background of the system as compared to fore-ground of the system; this is because of the varying emission factors. Improvement Analysis This analysis deals with the die-cast car model which is already in the market, the Life Cycle Assessment was done four people who took a period of around 10 months and four to six months for the study which after a new die-cast model car was then brought into the market. Usually many firms that specialized in designing the die-cast car model comes up with a new model that is competitive yearly. The time duration of new die-cast car model and old die-cast car model in the market is approximately one and half years. There is external use of the Life Cycle Assessment application for example; many firms may want to involve themselves in the external use of the assessment of the life cycle such as die-cast car model as A labeling of the environmental as 1 also. To expound on the effect of model A, labeling the environment on the market, the introduction of the product to the market should have labeling 1 at the beginning.(university, 2004, p. 163) There will be difficulty in the use of Life Cycle Assessment for models that come to the market for a very short duration of time due to the short frame of time. Designing die-cast model car can take a period of 5 to 10 months and the frame of time of the stage manufacturing is about 11 months before a new model is introduced. Manufacturing stage can be a little shorter when compared with the marketing stage but when major markets are put into consideration then the durations are almost the same. The character of the designed die-cast car model will define its duration and the stage use hence the most appropriate option for the time period to use the results of life assessment period is almost a year. The study on assessment of life cycle for die-cast car model may take five to ten months; there is less than five months available duration for communication of outcome of Life Cycle Assessment to the communal when the learning began on the position when the new die-cast car model appeared into the market. To increate the duration of communicating the outcome of life cycle assessment to third party, the model with short life in the market should have their life cycle assessment implemented in the stage of design or else there can be no space for external application use of life cycle assessment because it is an intensive time process.(2015, p. 154) Pre-excising methods are required in the beginning of the designing stage. The Life Cycle Assessment for this model is as follows: Development of life assessment cycle tool for a new die-cast car model group Collection of the data processes for assemblage of raw materials that are used in the die-cast car model group. Identification and collection of data of the product and its changes in specification during the design stage. Implementation of life assessment cycle on a new die-cast car model using the existing data that were made during the stage of manufacturing. In step one and two are the procedure followed before the implementation of life cycle assessment for the application which is external. These are the general steps for any new die-cast car model group: In step i, the methods of life cycle assessment for the die-cast model group like management of waste, rule allocation and usage of ways pattern are decided. The die-cast car model specific data are collected in step two. When step one and two are done, the duration for utilization in data collection and decision about methods of life cycle assessment are reduced. This is ready to be implemented as Life Cycle Assessment in the external parallel application of the die-cast model car design. The data and method that are made in step 1 and 2 can be used for long until the methods changes.(home, 2009, p. 142) Step 3 and 4 are specified steps for die-cast model car, in step 3, there is an identification of the differences between the old die-cast model car and the new die-cast model car. To know the components which are required in the collection of this specific data, designer of the die-cast model car and the practitioner of the Life Cycle Assessment are needed to make the decision. After the data available are screened, there is collection of new data components from the designer. The previously available components from the designer are collected easily and compared with the new once. According to the components that were unavailable before, the data collection is then done immediately after the designing of this components is completed. The die-cast car model designer and the practitioner of life circle assessment should closely operate together, the process is more important in the selection of the material and improvement of performance in the environment. The designer can measure the performance of the environment and provide another option when carrying out life cycle assessment of the die-cast model car in the design stage.(2016, p. 184) The environmental effects of plastics which are used as the part of the body of die-cast car model is also key root of environmental burden such eutrophiction, acidification and toxicity to the environment. The plastic parts of the model can be replaced by environmental friendly products like rubber. The Methyl methacrylate is a hydrocarbon compound which emits greenhouse gasses into the atmosphere and leads to global warming and depletion of the ozone layer. These gasses include CO, CO2, CH4 and CFCs. This compound can be replaced by a mixture of mould called ZAMAC, which is a compound of Zinc, Aluminum, Magnesium and Copper. Though ZAMAC is also hazardous to environment, but it can be applied because it is easy to control the pollution caused by these metals since the designers can decide to locate in one scarcely populated area and only soil is likely to be polluted.(BUWAL, 2001, p. 141) Glass that forms the components that make die-cast car model is also environmental unfriendly because it has a greenhouse effect by preventing the mixing of gasses. The components of glass can be replaced by rubber which is friendly to the environment and reduced the environmental burden through decomposing in the soil quickly. In the current toys, metals are minimized as much as possible, particularly Aluminum that is used together with Methyl methacrylate. The reduction of the metal is done by mixing die-cast and rubber. Conclusion The main reason for this project is to identify the hotspots throughout the die-cast car model for improvement of future. It is noted that the major phase contribution in the life cycle of a die-cast car model is the use phase. Energy saving mode also results to the total environmental performance of the of die-cast car model. The identified hotspots discussed above for a die-cast car model can be grouped into: packaging assembly and body assembly y the designers to improve option. These hotspots can be grouped into uncontrollable and controllable options. Controllable option is when a company can make improvements on its own or can influence the supplier directly to improve.(Vigon, 2000, p. 169) The designer can be asked by the company to reduce the impacts of the environment or burdens on specific environment or even explain the environmental upper limit burden so as to encourage the designers to performance of the environment and the die-cast car model hence the controllable option are grouped on economy relationship that is strong between the designers and the company. The controllable option is not always improved due to investment or technical void. The extraction of raw material associated with the environmental impact and the pattern use of are uncontrollable consumers. The connection between the manufacturers of the raw materials and the company is not strong hence the company cannot ask directly for the improvement of the performance of the environment for the die-cast car model or its designing.(2016, p. 110) The suppliers can be driven by the company since they are directly related to request for the raw materials manufacture to make improvement in the performance of the environment, this is difficult to achieve because direct suppliers are always smaller than the company that are processing the raw materials and have small chances of choosing their supplier of raw materials. In addition, the strategy for improvement for the label control option is separated into two groups depending in the investment cost and the duration period of the development. These strategies are: Long and short term strategies. The strategies that are short term are easily applicable and are of low investment cost. It is the selection of the supplier, reduction of requirement of raw materials, better packaging and design, and raw material replacement. This strategy is practiced in the design stage of the die-cast car model. The decisions on the strategy are grouped on the data process for the technology that is current in which the data is ready to be used therefore more data are required for the short term strategy. (2015, p. 114) References: Ann, M. (2015). Life Cycle student handbook. Newyork: Wiley. B, J. (2002). Hnadbook on life cycle assessment. 2001: Kluwer accademics pulishers. Boyd, S. B. (2001). Life cycle assessment of semi-conductors. London: Springer. BUWAL. (2006). Federal laboratories for material testing and resaerch. St Gallen: LERCHENFELDSTR. Ekologik, S. (2005). Lca it data base. Goteborg: CIT ecologic. Environmental life cycle assessment. (2015). Switzerland: CRC publisher. G, L. L. (2005). Nordic guidlines for life circle assessment. COPENHAGEN: Nordic counsil pf ministers. H, R. (2011). Life cycle assessment i build environment. Newyork: Spon press . Heugungs, R. (2002). Computational structure of LCA. Michigan: Springer. home, R. (2009). life assessment principles. Michigan: Csori publishing. Horn, R. (Csiro publishers). Life cycle assessment priciples. 2009: Autsralia. Johnson, D. (2004). Collectors guid to diecast toys. London: Collector books. K, W. (2014). LCA Guidlines to best practice. London: John weley. kloffter, W. (2001). Life assessment cycle. Newyork: IEEE. Koop, G. (2005). The ecoindicator. Nethelands: Amersfoort. Mcgimsey, K. (2006). Colector matchbox diecast toys. Michigan: Major production. Muthu, S. (2005). Socil life cycle ssessment . Delhi: springer. O, R. S. (2002). The EPS Enviro-accounting method. Goteborg: Swedish enveronmental institute. R, H. (2001). Environmental life circle assessment of products. Leiden: Center of environmental science. R, R. (2003). Evaluation of the environmental Impacts. Michigan: UNEP. RESEATCH, I. E. (2001). IVAN DATA BASE. Netherlands: ivan research. Rubic, F. (2005). Life assessment circle in industry and business. Michigan: Springer. S, K. (200). Screening LCA of a microwave oven . Brussels: SETAK CASE STUDIES SYMPOSIUM. Special types of life assesment . (2016). Netherlends: Springer. T, H. (2001). Finacial aca report of color. Suwon: sumsang electronics limited. T, H. (2005). Final LCA report of monitor. Suon: Sumsang electronics. university, B. (2004). Product design and life assessment. Bastic univercity press. Vigon, B. W. (2000). Life cycle assessment inventory guidlines and principles . Tokyo: Lewis publishers.

Price Discrimination Essays (1646 words) - Marketing, Microeconomics

Price Discrimination Prices are based upon the price elasticity of demand in each given market. In other terms, this means that during ladies night at the local bar, it costs more for men to have a beer than women simply because these bars find it o.k. to charge females less, as a way to draw more females to the business on a specific night. Price discrimination is part of the commercial and business world. Movie theaters, magazines, computer software companies, and thousands of other businesses have discounted prices for students, children, or the elderly. One important note though, is that price discrimination is only present when the exact same product is sold to different people for different prices. First class vs. coach in an airline (though sometimes just differing in how many free drinks you can get) is not an example of price discrimination because the two tickets, though comparable, are not identical. Price discrimination is based upon the economic thoughts and practice of marginal analysis. This process deals specifically with the differences in revenue and costs as choices and/or decisions are made. Profit maximization is achieved not when the number of products sold is the highest, nor when the price is the highest. Profitability price discrimination is only profitable if and when the given target groups price elasticity of demand differs to the point where the separate prices yield to profit maximization for each given group in question (where marginal revenue equals marginal cost). Groups that are more sensitive to prices, (students and senior citizens for example), have a lower price elasticity of demand and are the ones that are often charged the lower prices for the identical goods or services. The key to price discrimination and using it to fully compliment other economic practices, ultimately achieving the total profit maximization, is the ability to effectively and efficiently collect, analyze, and act upon data gathered about the different groups. First of all, the groups must be accurately identified and the differences between groups must be thought of ahead of time. Children, genders, and senior citizens are easily singled-out by appearance, while military personnel, college students, and other groups must carry some sort of identification. Firms typically will quote the highest prices in advertisements, and then offer discounts to qualified groups. The three basic conditions for price discrimination to be effective are: 1) Consumers can be divided into and identified as groups with different elasticities of demand. 2) The firm can easily and accurately identify each customer. 3) There is not a significant resale market for the good in question. The thought process behind the practice of first degree price discrimination is that the firm has enough accurate information about the consumer, and that products can be sold each time for the maximum amount that the consumer is willing to pay. The two more common examples of first-degree price discrimination is called price skimming and all-or-none offers. Skimming refers to the demand function, as firms take the top of the demand of a given good to maximize profits on the sale. This, of course, requires that the firm know the actual demand for the good that it produces. The firm must divide its customers into distinct, independent groups based upon their respective demands for the good. The firm wants to first sell to the group who will pay the highest price for the new product. It then reduces the cost slightly and sells to another group with only a slightly less demand for the good. This process is copied on numerous occasions until the marginal revenue drops to equal marginal c ost. While this example may seem similar to other examples of price discrimination, you should remember that the most significant difference here is that there are a virtually limitless number of possible prices that, if charges correctly, will lead to profit maximization in the end. The firm must, of course, be on the ball and must make constant changes of the demand, and the price for the good, at any given time, after the initial price is set, and a number of units are sold. Firms practicing price skimming will generally start their pricing schedules where the demand schedule has its vertical