Moving Through Change essays

Moving Through Change essays Common people have been through many changes in history such as technological change, economic change, and political change. Common people define history as a period of change. Technology will always change history for the common people as time goes on. Technological advancements in medicine have contributed to change. Many diseases such as smallpox, measles, cholera, plague and influenza were fatal. The changes in technology have made these fatal diseases disappear. For example, the invention of penicillin and a better understanding of microbiology have advanced Western medicine and public health that tackled these fatal diseases around the world. Millions of people hoped that the new drugs and medical technologies would give them better health and longer lives. Since the technological changes have been around the population in the around the world has increased drastically. For example the new generations can expect to live twenty years longer than their parents generation and newborns could live their lives all the way through the entire twenty- first century. This is why I believe that the common people define history as a period of change. Economic change will also change history for the common people as time goes on. Communication and business cross national boundaries; global politics are increasingly driven by global economics. For example as economics change through time new markets and economic technologies begin to transform peoples lives around the world. People born today, are born into a world which has been fundamentally transformed by economic change. Millions of people can now obtain a level of affluence once reserved for the privileged few, and their futures will depend less on individual effort and creativity. This is why I believe that the common people define history as a period of change. ...

Doblar Conjugation in Spanish, Translation, and Examples

Doblar Conjugation in Spanish, Translation, and Examples The Spanish verb doblar has several different meanings. It can mean to fold (like laundry or paper), to bend (like metal), to turn (like turn left or right while walking or driving), to double (like to duplicate), or to dub (like to translate a movie from one language to another). Doblar is a regular -ar verb. That means that it is conjugated similarly to other regular -ar verbs like cortar, enseà ±ar and cenar. In this article you can find doblar conjugations in present, past, conditional, and future indicative mood, present and past subjunctive mood, imperative mood, and other verb forms. Present Indicative Yo doblo Yo doblo la ropa despuà ©s de lavarla. I fold the laundry after washing it. Tà º doblas Tà º doblas la carta para ponerla en el sobre. You fold the letter to put it in the envelope. Usted/à ©l/ella dobla Ella dobla las ganancias de su negocio. She doubles her business' profits. Nosotros doblamos Nosotros doblamos la cuchara de metal. We bend the metal spoon. Vosotros doblis Vosotros doblis a la derecha en la esquina. You turn right at the corner. Ustedes/ellos/ellas doblan Ellos doblan la pelà ­cula al italiano. They dub the movie to Italian. Preterite Indicative In Spanish there are two forms of the past tense. The preterite describes completed actions in the past. Yo doblà © Yo doblà © la ropa despuà ©s de lavarla. I folded the laundry after washing it. Tà º doblaste Tà º doblaste la carta para ponerla en el sobre. You folded the letter to put it in the envelope. Usted/à ©l/ella doblà ³ Ella doblà ³ las ganancias de su negocio. She doubled her business' profits. Nosotros doblamos Nosotros doblamos la cuchara de metal. We bent the metal spoon. Vosotros doblasteis Vosotros doblasteis a la derecha en la esquina. You turned right at the corner. Ustedes/ellos/ellas doblaron Ellos doblaron la pelà ­cula al italiano. They dubbed the movie to Italian. Imperfect Indicative The imperfect tense describes ongoing or repeated actions in the past. It can be translated as was bending or used to bend. Yo doblaba Yo doblaba la ropa despuà ©s de lavarla. I used to fold the laundry after washing it. Tà º doblabas Tà º doblabas la carta para ponerla en el sobre. You used to fold the letter to put it in the envelope. Usted/à ©l/ella doblaba Ella doblaba las ganancias de su negocio. She used to doubleher business' profits. Nosotros doblbamos Nosotros doblbamosla cuchara de metal. We used to bendthe metal spoon. Vosotros doblabais Vosotros doblabais a la derecha en la esquina. You used to turnright at the corner. Ustedes/ellos/ellas doblaban Ellos doblaban la pelà ­cula al italiano. They used to dubthe movie to Italian. Future Indicative Yo doblarà © Yo doblarà © la ropa despuà ©s de lavarla. I will fold the laundry after washing it. Tà º doblars Tà º doblars la carta para ponerla en el sobre. You willfold the letter to put it in the envelope. Usted/à ©l/ella doblar Ella doblarlas ganancias de su negocio. She will doubleher business' profits. Nosotros doblaremos Nosotros doblaremosla cuchara de metal. Wewill bendthe metal spoon. Vosotros doblarà ©is Vosotros doblarà ©is a la derecha en la esquina. You willturnright at the corner. Ustedes/ellos/ellas doblarn Ellos doblarn la pelà ­cula al italiano. They will dubthe movie to Italian. Periphrastic  Future Indicative   Yo voy a doblar Yo voya doblar la ropa despuà ©s de lavarla. I am going to fold the laundry after washing it. Tà º vasa doblar Tà º vasa doblar la carta para ponerla en el sobre. You aregoing tofold the letter to put it in the envelope. Usted/à ©l/ella vaa doblar Ella vaa doblar las ganancias de su negocio. She isgoing to doubleher business' profits. Nosotros vamosa doblar Nosotros vamosa doblar la cuchara de metal. Wearegoing to bendthe metal spoon. Vosotros vaisa doblar Vosotros vaisa doblar a la derecha en la esquina. You aregoing toturnright at the corner. Ustedes/ellos/ellas vana doblar Ellos vana doblar la pelà ­cula al italiano. They aregoing to dubthe movie to Italian. Present Progressive/Gerund Form The gerund or present participle is the English -ing form. It is used sometimes as an adverb or for progressive tenses like the present progressive. Present Progressive ofDoblar est doblando Ella est doblando las ganancias de su negocio. She is doubling her business' profits. Past Participle The past participle is often used to form perfect tenses like the present perfect. Present Perfect of Doblar ha doblado Ella ha doblado las ganancias de su negocio. She has doubled her business' profits. Conditional Indicative The conditional tense is used to talk about possibilities. Yo doblarà ­a Yo doblarà ­a la ropa despuà ©s de lavarla si tuviera tiempo. I would fold the laundry after washing it if I had time. Tà º doblarà ­as Tà º doblarà ­as la carta para ponerla en el sobre, pero no la enviars. You wouldfold the letter to put it in the envelope, but you will not send it. Usted/à ©l/ella doblarà ­a Ella doblarà ­alas ganancias de su negocio si trabajara ms. She would doubleher business' profits if she worked more. Nosotros doblarà ­amos Nosotros doblarà ­amosla cuchara de metal si fuà ©ramos ms fuertes. Wewould bendthe metal spoon if we were stronger. Vosotros doblarà ­ais Vosotros doblarà ­ais a la derecha en la esquina, pero es el camino incorrecto. You wouldturnright at the corner, but it's the wrong way. Ustedes/ellos/ellas doblarà ­an Ellos doblarà ­an la pelà ­cula al italiano si lo hablaran bien. They would dubthe movie to Italian if they spoke it well. Present Subjunctive The present subjunctive is used to express a desire, doubt, denial, emotion, negation, possibility, or other subjective situations. Sentences that employ the present subjunctive require two clauses. Que yo doble Mi madre espera que yo doble la ropa despuà ©s de lavarla. My mother hopes that I fold the laundry after washing it. Que tà º dobles El cartero pide que tà º dobles la carta antes de ponerla en el sobre. The mailman asks that you fold the letter before putting it in the envelope. Que usted/à ©l/ella doble El jefe espera que ella doble las ganancias de su negocio. The boss hopes that she double her business' profits. Que nosotros doblemos Pedro no recomienda que nosotros doblemos la cuchara de metal. Pedro does not recommend that we bend the metal spoon. Que vosotros doblà ©is El navegador sugiere que vosotros doblà ©is a la derecha en la esquina. The navigator suggests that you turn right at the corner. Que ustedes/ellos/ellas doblen Pablo pide que ellos doblen la pelà ­cula al italiano. Pablo asks that they dub the movie to Italian. Imperfect Subjunctive There are two options for conjugating the imperfect subjunctive: Option 1 Que yo doblara Mi madre esperaba que yo doblara la ropa despuà ©s de lavarla. My mother hoped that I fold the laundry after washing it. Que tà º doblaras El cartero pedà ­a que tà º doblaras la carta antes de ponerla en el sobre. The mailman asked that you fold the letter before putting it in the envelope. Que usted/à ©l/ella doblara El jefe esperaba que ella doblara las ganancias de su negocio. The boss hoped that she double her business' profits. Que nosotros doblramos Pedro no recomendaba que nosotros doblramosla cuchara de metal. Pedro did not recommend that we bend the metal spoon. Que vosotros doblarais El navegador sugerà ­a que vosotros doblarais a la derecha en la esquina. The navigator suggested that you turn right at the corner. Que ustedes/ellos/ellas doblaran Pablo pedà ­a que ellos doblaran la pelà ­cula al italiano. Pablo asked that they dub the movie to Italian. Option 2 Que yo doblase Mi madre esperaba que yo doblase la ropa despuà ©s de lavarla. My mother hoped that I fold the laundry after washing it. Que tà º doblases El cartero pedà ­a que tà º doblases la carta para ponerla en el sobre. The mailman asked that you fold the letter to put it in the envelope. Que usted/à ©l/ella doblase El jefe esperaba que ella doblase las ganancias de su negocio. The boss hoped that she double her business' profits. Que nosotros doblsemos Pedro no recomendaba que nosotros doblsemosla cuchara de metal. Pedro did not recommend that we bend the metal spoon. Que vosotros doblaseis El navegador sugerà ­a que vosotros doblaseis a la derecha en la esquina. The navigator suggested that you turn right at the corner. Que ustedes/ellos/ellas doblasen Pablo pedà ­a que ellos doblasen la pelà ­cula al italiano. Pablo asked that they dub the movie to Italian. Imperative The imperative mood is used to give orders or commands. There are both positive and negative commands. Positive Commands Tà º dobla  ¡Dobla la carta para ponerla en el sobre! Fold the letter to put it in the envelope! Usted doble  ¡Doble las ganancias de su negocio! Double your business' profits! Nosotros doblemos  ¡Doblemos la cuchara de metal! Let's bend the metal spoon! Vosotros doblad  ¡Doblad a la derecha en la esquina! Turn right at the corner! Ustedes doblen  ¡Doblen la pelà ­cula al italiano! Dub the movie to Italian! Negative Commands Tà º no dobles  ¡No dobles la carta para ponerla en el sobre! Don't fold the letter to put it in the envelope! Usted no doble  ¡No doble las ganancias de su negocio! Don't double your business' profits! Nosotros no doblemos  ¡No doblemos la cuchara de metal! Let's not bend the metal spoon! Vosotros no doblà ©is  ¡No doblà ©is a la derecha en la esquina! Don't turn right at the corner! Ustedes no doblen  ¡No doblen la pelà ­cula al italiano! Don't dub the movie to Italian!

Rapunzel Essay Example | Topics and Well Written Essays - 1000 words

Rapunzel - Essay Example It so happens that Rapunzal’s real mother, during her long-awaited pregnancy demands the fruit of Rapunzel plant grown in the neighboring garden. Her husband complies with the same, but is caught by the owner Dame Gothel, who frees him with the promise of handing the coming child to her. Consequently, the parents surrender to Dame, which confides the girl in a magical tower having no stairs or other source to reach. Dame herself assures her entrance to climb over the tower by holding the girl’s very long blonde hair she offers by felling the same through the window of the tower. Since the girl, named Rapunzal, is not familiar with the outer world, no one has got acquaintance with her dwelling in the tower. Somehow, a prince discovering her voice while singing, and detected the way to reach her during night hours. The both fall in love and promise to get married. However, Dame detects the affair, deprived Rapunzal of her hair and kicks her out of the tower. She also fell s the prince from the tower, and the fall deprives him of his eyesight. Both the two spent many years in wandering, and subsequently reunited with the help of the same singing voice of the girl. The prince leads her to his kingdom where they enter into marital knot and thus lead a happy life for the rest. Since the fairytale invites the curiosity of the readers for the explanation of theme and symbols involved in the story, the present paper aims to throw light on the same by applying psychoanalysis of the story. Presented by illustrious Austrian psychologist Sigmund Freud, psychoanalytic theory specifically concentrates upon the erotic feelings prevailing in human mind. He not only declares sexual gratification as one of the most imperative thing in human conscious and subconscious, but also interprets every dream as the outcome of unfulfilled sexual desires. Somehow, his theory is not confined to sexual gratification only. Rather, all the actions providing mental and physical plea sures are the part of his theory. The same can be witnessed in the story under analysis, where Rapunzal’s mother forces her husband to pluck the plant from the adjacent garden for her, and the husband acts upon her instructions without taking legal and moral legitimacy of the theft on the one hand, as well as the outcome of his entering the garden without permission on the other. (1-2) The same is the case with the enchantress, which turns extremely haughty and revengeful towards him, and demands the most precious thing the couple has been waiting for the last several years i.e. their coming child. Thus, the small wish to taste the fruit of a plant that did not belonged to the couple deprives them of the beautiful child they have been waiting vey anxiously for a long time as the greatest joy their life. The enchantress’s keeping Rapunzal confined in the tower far from the eyes of the people also reflects upon the very fact that she does not allow any sharing in the lov e between her and the adopted daughter. She provides all basic necessities to the girl, but fails to comprehends with the reality that when the god Eros hurls his arrow in the heart of the individuals, it is really hard to escape its affects altogether. The same is the case with the young girl, who cannot resist the charm of love growing in her heart at her first meeting with the prince, and is captivated with the sweet words he delivers in her praise. It not only urges the wish to attain freedom from her many years long imprisonment, but also seduces her to make erotic love with the prince. Hence, carnal desires overcome the feelings for her so called mother, which forces her put her life at stake in the pursuit of physical love. Here appears the

Research Utilization Paper Example | Topics and Well Written Essays - 2000 words

Utilization - Research Paper Example This happens in different forms and kinds, including in the breast. Cancer that affects the breast is called breast cancer. This is one of the most prevalent forms of cancer. Although breast cancer is said to have been first reported in Egypt around 122 B.C, there are no accurate statistics that can clearly prove its earliest reported cases. However, according to the journal, Phenomenal Woman, Hippocrates was the first to give a logical and medical explanation of breast cancer in 460 B.C (2008). This development was further expanded by the works of Galen at around 200 A.D. Since then, more studies and medical research have been done to discover explicit knowledge about the disease. Breast cancer is caused by a number of factors commonly called breast cancer risk factors. Breast Cancer Breast cancer is one of the types of cancers. It manifests itself in the breast. It originates from the milk ducts or lobules of the breast. Although it typically occurs in women, breast cancer can also attack men as well. Breast cancer occurs in the form of a lump on the breast or the side of an armpit. This lump contains thick tissue which is not uniform with the rest of the breast tissue. It can be noticed by simply touching the breast gently to feel the thickness of its inner tissue. Another way of detecting breast cancer is through the observation of any abnormal growth or development in the breast. Such abnormalities are physically observable features of a breast. For instance, some breast cancer cells cause the nipple of one breast to be inverted in such a way that it seems to grow towards the inside of the breast rather than the normal way of growing towards the outside. There could also be skin dimpling or change in skin color at the part of the breast where cancer has attacked the breast tissue. One of the breast cancer risk factors is the transfer of genes responsible for certain types of cancers from parent to child. Breast cancer can be passed from a child bearer to t he baby. This means that the breast cancer cells can be passed from one generation to another through the genes. In such cases, if a mother or father has breast cancer cells, then they can be passed to their offspring or to subsequent generations of their offspring. Another major cause of breast cancer is contributed to lifestyle. This means that the way people conduct their day to day activities has an influence on their chances of getting or preventing breast cancer. Smoking of tobacco has been identified as one of the major lifestyle causes of breast cancer. Lack of breast feeding after child birth also increases a woman’s chances of suffering from breast cancer. In addition to that, abortion also increases the chances of a woman suffering from breast cancer. A poorly conducted abortion procedure can easily result in breast cancer. Breast cancer is typically classified on a number of bases. For instance, when classified according to origin, we have ductal cancer and lobula r cancer. Ductal originates from milk ducts while lobular cancer originates from lobules. When classified according to the stage of the development and spread of the cancer cells, the TNM system is used. The level T is when the cancer cells have only attacked the armpit. The level N is when the cancer cells have spread from the armpits to the whole breast while the level M is when the cancer

Longitudinally Extensive Transverse Myelitis Patients

Longitudinally Extensive Transverse Myelitis Patients Characteristics of Longitudinally Extensive Transverse Myelitis patients: a retrospective analysis of 40 consecutive cases at a tertiary care hospital from North-West India Abstract Longitudinally extensive transverse myelitis (LETM), characterised by spinal cord inflammation extending three or more vertebral segments may be caused by multiple disorders most common being neuromyelitis optica(NMO). Such is the frequent association between these two entities that there is a growing concern to regard them as being practically synonymous with each other. However, all potential etiologies should be considered in the assessment of LETM. We conducted retrospective analysis (2010-2014) of 40 patients of LETM for demographic features, clinical presentation, laboratory investigations and neuro-imaging. Result: Majority of the patients presented acutely with bladder dysfunction and paraparesis. Ten out of 40(25%) were classified as NMO among which only 4 were serum NMO antibody positive. Among the rest, there were 6 patients of MS, 3 patients of tubercular, 2 patients each of ADEM, spinal AVM and postinfectious etiology, one patient each of SACD and SLE. A group of 13 pati ents remained in whom no causative factor could be identified from the available investigations. Conclusion: LETM even with optic neuritis does not universally represent a diagnosis of NMO and one needs to be cautious while making a diagnosis of NMO without consideration of other etiologies as the treatment and prognosis differs among different etiologies. Abbreviations: MS (multiple sclerosis); AVM (arteriovenous malformation); SACD (subacute combined degeneration); ADEM (acute disseminated encephalomyelitis); TM (transverse myelitis). Key words: Longitudinally extensive transverse myelitis; Neuromyelitis optica Introduction Longitudinally extensive transverse myelitis (LETM) is a relatively recent term designating a transverse myelitis(TM) that extends three or more vertebral segments vertically. These lesions, which may occasionally span the entire length of the spinal cord, are much rarer and in general associated with greater morbidity than the typical lesions of idiopathic TM or multiple sclerosis (MS) associated TM(1). The key discriminating feature of LETM lesions is their length. The most frequent cause of LETM is neuromyelitis optica (NMO). In recent times the association between these two conditions has been so heavily emphasized that when LETM is encountered, an erroneous diagnosis of NMO may be made prior to careful consideration of other potential etiologies of LETM(1). Thus, early recognition and establishment of the aetiology of LETM from appropriate workup is essential for optimizing outcome and in some cases commencing appropriate treatment to prevent future attacks of central nervous system (CNS) inflammation. Studies comparing clinical, laboratory and radiological profiles of the LETM patients are scarce, especially from the developing countries. Thus, this study was conducted to review the characteristics of presentation and etiological classification of LETM at SMS Medical College and Hospital, Jaipur, a tertiary care centre of North India. Patients and Methods The study is a retrospective analysis (2010-2014) of 40 patients classified as having LETM on the basis of clinical manifestations of myelitis and spinal MRI finding of lesions typically extending three or more vertebral segments in length, admitted in SMS Medical College and Hospital, Jaipur with the following objectives:- To study the clinical, radiological and CSF profile of patients with LETM. To determine the aetiology of the myelitis. Patient demographics, presenting symptoms, clinical manifestations and investigations were recorded on data entry forms. The investigations included routine blood profile along with markers of connective tissue disorders (ESR, CRP, ANA, Anti dS DNA), MRI (of involved spinal cord segments in T2-weighted images of spinal MRI and MRI Brain), CSF analysis (including oligoclonal bands) and serum NMO antibody (NMO Ab) which was done by indirect immunofluorescence method. Results 40 patients were found to fulfil the LETM criteria. 22 among the 40 patients were less than 30 years age (55%). Overall Mean age was 28 years with male: female ratio of 1.8:1, suggestive of male preponderance. Apart from it no specific trend was observed among the study group in terms of their demographics. The majority of patients presented with bladder dysfunction, paraparesis and quadriparesis. Most of the patients had an acute presentation. Collectively, thoracic spinal cord segment was most commonly involved. 12 patients had clinically significant vision impairment at the time of presentation of which 10 were classified as NMO according to Wingerchuck et al criteria, one case was classified as MS and another was a case of SACD (Table 1). Table 1: Presenting Clinical features Table 2: Radiological Findings Cerebrospinal fluid (CSF) pleocytosis was seen in 55 %( 22 out of 40 patients) ranging from 10 to 250 cells/cumm. Among 10 NMO patients, 5 showed CSF pleocytosis of which 2 had neutrophilic predominance. The maximum cell count among NMO patients was 35 cells with lymphocytic predominance. Apart from it, 3 patients of tubercular, 2 patients each of postinfectious etiology and ADEM , one patient of MS and 4 patients of undetermined etiology also showed CSF pleocytosis. The maximum CSF cell count was 250 cells in one of the tubercular patient with lymphocytic predominance. CSF proteins were elevated in 15 out of 40(37.5%) patients of which 3 patients were each of MS and tubercular etiology, 2 patients each of NMO and postinfectious etiology and 5 patients were of undetermined category. Out of 40 patients, 18 had extensive lesions involving >6 spinal cord segments .Among 38 patients in whom MRI brain was done, 10 showed abnormalities, of which 5 patients were of MS, two were each of ADEM and tubercular etiology and another one was NMO (NMO Ab positive) (Table 2).Among the MS patients, abnormalities were seen involving deep white matter of bilateral cerebral hemispheres, corpus callosum, brainstem and basal ganglia. Based upon the above-mentioned clinical presentation and investigations, patients were classified according to their etiologies (Table 3). Table 3: Etiology of LETM patients 10 patients were of NMO fulfilling revised diagnostic criteria for neuromyelitis optica by Wingerchuk et al (7). In 8 out of 10 patients NMO antibody was sent, 2 patients refused for it. 4 out of them were NMO Ab positive and remaining 4 were negative. Among 10 NMO patients only one patient had lesions in MRI brain typical of NMO (Figure 12)). Four of ten patients in whom serum NMO Ab was done showed positivity and one of the NMO Ab positive patient had brain MRI abnormality involving brainstem, posterior part of corpus callosum, left parietal periventricular white matter. Six patients were of MS fulfilling the revised McDonald criteria for diagnosis of MS. Three patients were of tubercular myelitis ,two patients each were of ADEM , postinfectious etiology, and spinal AVM. One was having nutritional cause in form of vitamin B12 deficiency and one patient had SLE (ANA dsDNA positive). Rest of the patients could not be categorised to a definite etiology from the available investigations. Discussion In our series, common presenting symptoms were bladder dysfunction, paraparesis, quadriparesis, and visual impairment. Majority of the patients studied suffered from bladder dysfunction and paraparesis. It is a difficult task to determine the underlying etiology of LETM and it is worth exploring each case for subtle clues that may point toward the correct underlying diagnosis as the prognosis and long-term treatment decision differs in each category. Till now there are no studies describing association of clinical features and demographic features with the etiology of the myelitis (2). In our series the maximum CSF cell count (250) was in tubercular patient. Maximum CSF cell count in NMO and MS patients was 35 and 30 respectively. It is now well established that LETM does not universally represent a diagnosis of NMO, even in the setting of optic neuritis. However, in our series demyelinating disorders were found to be the most common cause of LETM and NMO was the most common etiology among demyelinating disorders. All NMO patients fulfilled the criteria laid down by Wingerchuk et al (3). Among ten NMO patients, four were NMO antibody positive. Three main laboratory techniques are utilized in identifying the antibodies. In our patients it was done by the indirect immunofluorescence method which has the reported sensitivity and specificity of 86% and 91% respectively (4). At present, it is unclear whether there is truly a subset of patients with clinical NMO that are NMO antibody negative, or if this is a result of inadequate sensitivity of existing immunoassays to detect the antibody, or inadequately sensitive and specific diagnostic criteria, or a combination of all of these factors. Although a regular follow up was not available in all NMO patients, a telephonic survey revealed that four NMO patients, of which two were seronegative and in two NMO antibody was not done, had no relapse and are doing well. Apart from this, one patient died from subsequent relapse and one could not be assessed in follow up. Among the four NMO antibody positive patients, who were under regular follow up, two (50%) presented with relapsing- remitting form of illness. One was 25 years old male who initially had 4 episodes of paraparesis with near complete recovery each time and developed vision impairment in the fifth episode and another was a 12 year old girl who had four relapses with simultaneous occurrence of vision impairment and paraparesis in the first episode. Thus, 4 patients had a monophasic disease course in 1 year follow up. However, a diagnosis of monophasic NMO should be considered with caution, because more than 90% of patients with NMO ultimately develop a relapsing cou rse. One prospective Class I study found that the presence of aquaporin-4–specific autoantibodies (AQP4) predicts recurrence of TM or conversion to NMO(5). So was our observation in the form that out of the 3 patients who had relapse, 2 were NMO antibody positive. Therefore, we speculate that AQP4 antibody status, particularly seropositivity, has some predictive value. Median age of onset of NMO is in the fourth decade. In our series all NMO patients were below 40 years of age except one who was a 52 years old female (figure 3).Interestingly this patient apart from late onset, also presented with slowly progressive paraparesis of one year duration which has not been described earlier in the literature. In spinal NMO lesions, the central part of the cord is commonly affected, including both grey and white matter with peripheral sparing (figure 3). These imaging features may therefore help to differentiate MS from NMO in patients who present with LETM(6). Among the NMO antibody positive patients, one had typical brain lesions of NMO (Figure 1). In patients with clinical and radiological features otherwise typical for NMO, 60–85% of cases have been shown to have abnormal brain lesions. Lesions involving the diencephalon and brainstem distinctly atypical for MS have been commonly reported in NMO patients. These distinctive lesions predominately involve the hypothalamus and can extend to brain tissue surrounding the third and fourth ventricle and aqueduct of Sylvius and seem to be characteristic brain lesions of NMO(7). There were 13 patients in whom a definite etiological diagnosis could not be made from the feasible investigations. This group is usually described in the literature as ‘idiopathic’. However, the idiopathic nature is a diagnosis of exclusion. In our series whether these patients were belonging to the category of postinfectious or some other form of demyelinating etiology was not clear from the investigations that were done in these patients as these patients were also later lost to follow up. Among 3 patients who were classified as tubercular on the basis of reactive CSF and positive TB PCR, one had intramedullary spinal tuberculomas (Figure 4). Intramedullary tuberculomas (IMT) are seen in only 2 out of 100,000 cases of tuberculosis and 2 out of 1,000 cases of central nervous system tuberculosis, are even rare as a cause of LETM(8).Out of these three, one had complete recovery with ATT and remaining 2 had poor outcome with bedridden status. Among 40 LETM patients, we were able to categorise only two patients as ADEM on clinical and radiological grounds (Figure 5).Both patients were of paediatric age (14 and 16 years) group, had complete and rapid recovery with no recurrence on 6 month follow up, which made the diagnosis even more certain, and correlated with the fact that monophasic course is the hallmark of ADEM. MRI features of ADEM that are unusual in MS are symmetric bilateral disease, relative sparing of the periventricular white matter and deep grey matter involvement (9). However, 22% of ADEM patients had a periventricular lesion pattern indistinguishable from that seen in MS (10).Similar radiological features were observed by us in both patients (Figure 5 and 6). The radiological features of spinal cord involvement in ADEM in adults have not been well studied. In a small Dutch series, one-third of patients had lesions extending more than two vertebral segments on spinal MRI at presentation (11). Approximately 75 % patients with ADEM have a preceding infection, and by definition there will be evidence of demyelination within the brain, as well as in the spinal cord, as seen in our patients (Figure 6). These features may help to differentiate ADEM from NMO spectrum disorders. Among the metabolic causes, subacute combined degeneration (SACD) of the cord due to vitamin B12 deficiency can produce longitudinally extensive hyperintense signal on MRI imaging as seen in one of our patient (Figure 7). Generally T2 weighted scans demonstrate focal high signal abnormalities in the white matter of the dorsal and posterior columns in SACD (12). In conclusion, the differential diagnosis of LETM is broad. Although characteristically associated with NMO, this diagnosis accounts for less than half of cases of isolated LETM in adults, and may be even less common in children. Patients presenting with LETM require a thorough work-up to exclude other treatable causes particularly infectious and inflammatory. The management of LETM is dependent on distinguishing inflammatory from non-inflammatory aetiologies and in identifying patients who are at high risk of further attacks. Figure Legends Figure 1: MRI brain showing hyperintensities (arrowheads) involving brainstem, left parietal periventricular white matter, posterior part of corpus callosum in seropositive patient of NMO (12 year old girl) Figure 2: MRI cervical spine T2 weighted sagittal and axial images of same patient showing predominant involvement of central grey matter (arrowheads). Figure 3: MRI cervical spine T2 weighted sagittal and axial images of 52 years old NMO antibody positive female showing predominant involvement of central grey matter. Figure 4:T2 weighted sagittal and axial images showing hyperintensity (arrowheads) in cervical cord with contrast enhancement suggestive of tuberculoma. Figure 5: MRI cervicodorsal spine, T2 weighted sagittal and axial images of a 16 year old girl with ADEM.MRI brain of the same patient showed lesions (arrowheads) in basal ganglia, brainstem and cortex typical of ADEM. Figure 6: MRI brain and spine of a 14 years old male with ADEM showing hyperintensities in brain involving bilateral periventricular white matter and long segment hyperintensity in the cord extending upto conus. Figure 7: Hyperintense signal in posterior aspect (arrow) of cervicodorsal cord in T2 weighted axial and sagittal images of SACD patient. References Eckstein C., Syc S. and Saidha S., â€Å"Differential diagnosis of longitudinall extensive transverse myelitis in adults† ENJ 2011; 3 🙠 1). July 2011. Scott T., Frohman E., De Seze J. et al., Evidence-based guideline: Clinical evaluation and treatment of transverse myelitis. Neurology; December, 2011 Wingerchuk et al. Revised diagnostic criteria for NMO. Neurology 2006;66:1485-9 Waters P, Vincent A. Detection of anti-aquaporin-4 antibodies in neuromyelitis optica: Current status of the assays. Int MS J 2008; 15:99-105. Weinshenker B, Wingerchuk D, Vukusic S, et al. Neuromyelitis Optica IgG predicts relapse following longitudinally extensive transverse myelitis. Ann Neurol 2006; 59:566–569 Wingerchuk, DM. Neuromyelitis Optica Spectrum Disorders. Continuum Lifelong Learning Neurol 2010; 16(5): 105-121 Brain Abnormalities in Neuromyelitis Optica Spectrum Disorder K. Woojun, K. Su-Hyun, H. So-Young and K. Ho Jin Multiple Sclerosis International Volume 2012. Imaging Diagnosis of Spinal Intramedullary Tuberculoma: Case Reports and Literature Review Lu Ming J Spinal Cord Med. Apr 2010;33(2):159 162 Kesselring J, Miller DH, Robb SA, et al. Acute disseminated encephalomyelitis. MRI findings and the distinction from multiple sclerosis. Brain 1990;113(Pt 2):291–302 Dale RC, de Sousa C, Chong WK, Cox TC, Harding B, Neville BG. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain 2000; 123(Pt 12):2407–2422 Ketelslegers I, Visser I, Neuteboom R, Boon M, Catsman-Berrevoets C and Hintzen R. Disease course and outcome of acute disseminated encephalomyelitis is more severe in adults than in children. Mult Scler 2011; 17(4): 441–448 Larner A, Zeman A, Allen C. MRI appearances in subacute combined degeneration of the spinal cord due to vitamin B12 deficiency. JNNP 1997;62:99-101.

Madness and the Freedom to Live: Into the Wild

A young man, living in a comfortable civilized environment leaves society and all the benefits that he had behind him to build a new life. The novel Into the Wild by Jon Krakauer tells the story of a young man, Chris McCandless who had always believed his life ritual was based on mental knowledge. The existential mind of McCandless seemed to prove this statement true. His effort he put into his work was nothing compared to what would lie ahead on this so called â€Å"journey† of his. He loved the fact that each day he had the possibility of being exciting, different, or even dangerous. Chris was different in the way he wanted to experience life. He wanted to be alone and took no joy in the various human relationships that he had developed in his travels. Chris showed that he was a loner and did not value these relationships by his disregard for normal society and only took pleasure in challenging himself. To part from all society, one’s mind needs to be set; for once one was there, to come back would be a challenging task. A quote from the beginning of chapter six states, â€Å"No man ever followed his genius till it misled him. Though the result were bodily weakness, yet perhaps no one can say that the consequences were to be regretted, for these were a life in conformity to higher principles† -Henry David Thoreau (Krakauer 47). Any human, man or woman, may see the mental capabilities they have, but never portray them in anything worth dying for. The judgments of anyone could be overrode by something as simple as a thought or pigment of curiosity in one’s mind. McCandless went through this exact same thing during his short-lived life. Once the thought of living without society had crossed his mind, he had been fixed on making it possible. Every little occurrence over the period of time McCandless spent in Alaska began to show it. The little amount of supplies he had ran out quickly and the effect was tragic and fatal. The accomplishments he had acquired from taking this journey affected him in the long run. Though McCandless is deceased, the phenomenon of his story lives on, and one can certainly believe that he did not regret anything he put himself through. He may not have learned from his own mistakes, but others can learn from the aberrations McCandless put upon himself. Thoreau states, â€Å"If the day and the night are such that you greet them with joy, and life emits a fragrance like flowers and sweet-scented herbs, is more elastic, more starry, more immortal, —that is your success† (Krakauer 47). The concepts and visions McCandless perceived and lived can be recognized throughout this statement. He looked at the possibilities in life in a positive manner, and the outcome of doing this was appreciation, love, and most importantly, success. Thoreau also states, â€Å"All nature is your congratulation, and you have cause momentarily to bless yourself. The greatest gains and values are farthest from being appreciated. We easily come to doubt if they exist. We soon forget them. They are the highest reality†¦ The true harvest of my daily life is somewhat as intangible and indescribable as the tints of morning or evening. It is a little star-dust caught a segment of the rainbow which I have clutched† (Krakauer 47). In McCandless’ mind, the only thing he wanted was this. Every little speck of appreciation all showed towards the beautiful mother nature; she is what held his head high, and kept him going throughout his journey. Anthony Storr wrote; â€Å"It is true that many creative people fail to make mature personal relationships, and some are extremely isolated. It is also true that, in some instances, trauma, in the shape of early separation or bereavement, has steered the potentially creative person toward developing aspects of his personality which can find fulfillment in comparative isolation† (Krakauer 61). This is an extremely relevant statement about McCandless and his actions. It illustrates the observations between him, and his father. He may be a very intelligent person, and he may be a straight â€Å"A† student, but the failure to be able to obtain a good, close relationship with his father drove him away. But if any person ever got the chance to go through something like McCandless did they would be very distant as well. The fortunate aspects and outcomes of such, allowed him to start over and begin a new life of his own. Rather than love, than money, than fame, give me truth. I sat at a table where rich food and wine in abundance, and obsequious attendance, but sincerity and truth were not; and I went away hungry from the inhospitable board. The hospitality was as cold as the ices† -Henry David Thoreau (Krakauer 117). This quote emphasizes the fact of McCandless looking for something that could not be found. The truth he looked for every day of his life had the inab ility to stay hidden. It tended to squish though ever crack and crevice in the wall his father tried to put up between them. All McCandless wanted was the truth, and all his father had done was separate himself from McCandless more and more. He wanted nothing more in life but to know what was really going on, but the incompetence of his father’s actions caused the two to separate. The perseverance of McCandless’ life showed greatly throughout the readings of this book. Every bit of information lead to give the reader understanding of who McCandless was, and why he did what he did. His story was an excellent acknowledgement to what he had accomplished. The love McCandless showed towards nature and interest of starting over allowed him to live this dream. The encouragement given to him was taken in a very special manner, and every step McCandless took, was written down as if his life were an epic novel. The troubles and hardships he had gone through and success he had gained was all lost, as his body was found later in an abandoned bus.

Solar An Alternative Energy Source - 868 Words

Title: Solar as an Alternative Energy Source Meta Tags: alternative energy, benefits of alternative energy, alternative energy sources, alternative sources of energy, alternative energy companies Meta Description: Save money and examine the positive impact of using the sun s rays as an alternative source of energy. With the availability of coal, oil and natural gas more limited every day, many people are turning to the oldest and most abundant source of power on Earth -- the sun. Solar energy uses the natural energy-making process of photosynthesis for plants and offers a reliable alternative energy source for homeowners and businesses seeking a cost-effective solution to rising energy bills. Why Choose an Alternative Energy Source People have relied on the power of fossil fuels for hundreds of years. Fossil fuels are used to make coal, oil and gas that powers cars, factories and homes. These fuels are burned to meet the needs of most of the energy consumption throughout the world. When considering the popularity of fossil fuels, many wonder why people should consider an alternative energy source. According to the [Union of Concerned Scientists], several negative consequences result from the burning of fossil fuels. Burning fossil fuels releases extra carbon dioxide into the atmosphere, destabilizing an already delicate balance that results in global temperature changes. These changes affect sea levels and climate patterns, wreaking havoc on economies around theShow MoreRelatedSolar Energy As A Alternative Energy Source2941 Words   |  12 PagesIntroduction The concept of solar energy is not a new one. We have seen it in practice from solar powered calculators, garden lights, watches, and a wide variety of other novelty products. However, the idea of solar energy as a sustainable, renewable form of electricity, is on another level completely. 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