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Brainstorming for the Narrative Essay: Memory Mining. Last week here at systems Writing Center Underground, we discussed several different invention strategies to uncover engaging persuasive essay topics. This week, we’ll focus our brainstorming on uncovering essay topics for fantasy theme, the Narrative Essay. Narrative essays tell a story. In English classes, most instructors ask students to tell a story about information themselves, such as an event from the past or a story about african woman their family. Narratives can be quite personal, and students have the systems opportunity to be creative, utilizing fictional techniques including dialogue, description, characterization and plot development. Choosing a narrative topic that meets assignment guidelines as well as maintains readers’ interest is ledc medc, often daunting for beginning writers, but spending a little time utilizing several invention strategies will set you on your way to an engaging narrative topic and an entertaining essay. Invention strategies will be different for tesco information systems, a narrative essay than for a persuasive essay.

Narratives will draw more on personal experience, so for narrative essays, we’ll do what’s called memory mining . Memory mining is simply brainstorming to uncover memories of people, places, events, and spill, experiences. Information? To simplify, we’ll break our memories down into ledc medc categories. Tesco Systems? Try to list at least 3 memories for each category. Memories of people. Memories of your immediate family are obvious, but consider other people who may have influenced your life.

Did you have a favorite teacher or coach? Did you have a first boss who was a mentor? Did you meet someone who left a profound effect on your life? List the person and wegmans employee, a brief note on why they come to mind. Below are some examples that could become an systems intriguing story: My high schoolhistory teacher taught me the importance of learning from our past My grandmother’s love of baking The homeless man I passed each day on the way to the bus stop. Axia Wiki? Memories of times and tesco, places. If I were to ask you to recall a place from your youth, I bet it would be easy. Places are full of memories of sights, sounds, smells – the making of a great narrative essay. Places can be inside home or outside in the city or country.

A place could be a garden or a doctor’s office. Think of “time” in terms of era: junior high science lab; the summer you broke both your legs and define witch trials, spent the time in your bed; the maple tree where you kissed your first boyfriend over winter break. Work past the obvious and list as many times and places as you can. Early autumn in the Tennessee mountains The first day of information systems deer hunting season Your Quinceanera. Memories of british petroleum gulf events. Often when we think of “events,” we immediately thing big – graduation, wedding, birth, death – but an event doesn’t necessarily have to be a big occasion. An event could be your last day of high school, saying goodbye to your favorite teacher. Information? It could be a tornado drill at british petroleum school when you got to snuggle close to the girl/boy of tesco information your dreams. It could be the first time you drove a car and went the wrong way down a one-way street (was I the only one who did that?).

Think outside the box. Getting a black belt in karate The first – and last – time you sat on Santa’s lap Parents’ silver wedding anniversary. Memories of happy experiences. This might be an event, but could also be something simple, like a bubble bath or working Thanksgiving in a homeless shelter. Think small and large when brainstorming happy experiences. Ledc Medc? Catching the winning touchdown pass Opening the letter of tesco information acceptance from the journal where you submitted a poem Senior prom. Memories of unhappy experiences. We’ve all had unhappy experiences, but trying to determine which ones might make a good essay can be challenging. Think in terms of how you will tell the story of your unhappy experience before you commit it to paper. Axia? A break-up or death may come to mind first, but take some time to consider if there is a story in tesco systems the experience that others can derive meaning from. Being pulled over by the police Wrecking my father’s beloved Camero Being ejected from the final game and disappointing my teammates.

Memories of accomplishments. Accomplishments can be big or small. The emotions we might feel after accomplishing something might range from elation to sadness. Winning an define salem witch award Completing the marathon Hitting weight loss goal. Supporting Ideas: Testing Your Topic. If you’ve spent some time memory mining, you should have a good list of topic ideas. Now you can begin to brainstorm supporting ideas. Tesco Information Systems? Pick one of your favorite topics you’ve uncovered, and list related memories as they come to traditional african woman, mind. For example, one student might choose her grandmother’s love a baking. Here is information, a list of memories surrounding that topic: Grandma baked iced sugar cookies every Christmas. specialty was pecan pie. always wore her blue floral apron. let me lick bowl. types of cookies. favorite Betty Crocker cookbook. colored frosting and sprinkles. kitchen smelled good. Perodua Axia Wiki? singing along to Elvis music.

Dad only tesco ate unfrosted cookies. I learned how to traditional african woman, use mixer. she let me add ingredients. learned to read recipes. I was glad sister didn’t like to help. made extra frosting so I could eat it. wrapped cookies in box and gave as gifts. couldn’t bake as she got older. I baked for systems, her and fantasy theme, she helped decorate. This is a long list, and every related memory may not make it into the final draft. If you have too much material for your essay, decide what the main ideas you want to write about are. In our narrative, we want to show Grandma’s love of baking and how she passed it on, so the details of Grandma’s actions and tesco systems, what the writer learned from Grandma are important. Other details, such as the writer’s feelings about her sister, her Dad’s favorite cookies, or which cookbook Grandma used, may be less important and british petroleum spill, can be omitted. Once you decide what the story is you want to tell, you’ll begin to see what the important memories are, the focus will gradually become clearer, and information, the story will start to spring from the memories.

Writing Center Underground is supported by perodua axia Metropolitan Community College in Omaha, Nebraska and maintained by Elizabeth Mack, Writing Center consultant. The Writing Center, staffed by experienced English teachers and writing consultants, provides professional assistance and systems, outreach programs to help students and employee discounts, faculty with written communication across the disciplines and tesco information systems, beyond. Simply stated, the Writing Center is a place into which writers invite other writers to dialogue about writing. View all posts by E. British Spill? Mack. 4 thoughts on “ Brainstorming for the Narrative Essay: Memory Mining ” this is great! Thank you!

Thanks for visiting our blog Brent! I#8217;m teaching my first high school class next week and we are doing a unit on personal narratives! I#8217;m totally using this for the brainstorming.

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ob rn resume Presentamos nuestra experiencia prospectiva de cerclaje cervical electivo (CCE) con técnica de McDonald, en pacientes con historia obstétrica sugerente de incompetencia cervical uterina (IC), y los resultados perinatales, en 4 años de estudio. PALABRAS CLAVE: Cerclaje cervical electivo, incompetencia cervical. We present a prospective experience in tesco, elective cervical cerclage, with McDonald technique in petroleum spill, patients with obstetric history of systems cervical incompetence, and axia, perinatals outcome in tesco systems, four years. KEY WORDS: Elective cervical cerclage, cervical incompetence. L a incompetencia cervical (IC), mencionada por Culpepper, Cole y Rowland en 1658, y descrita en el Lancet por Gream en 1865 toma su real dimensión cuando Palmer y Lacomme en el año 1948 recomiendan su tratamiento, y luego Lash y Lash proponen el término de IC para definir este problema en 1950 1 . Traditional. Shirodkar introduce el cerclaje cervical con cinta “en ceñidor” el año 1955, y por su parte en 1957 Ian McDonald presenta su experiencia con una técnica simple de punto no absorbible y señala que: “la historia obstétrica de la paciente constituye el factor más relevante para corroborar el diagnóstico” 2 . Tesco. En 1965 Benson y Durfee describen un procedimiento transabdominal eficaz de cerclaje cérvico ístmico en vez de CC transvaginal 3 , y luego de estudios alternativos Golfier y cols apuntan que la vía vaginal para el cerclaje cérvicoistmico en la zona más alta posible, tiene ventajas y es más simple y rápida que la vía transabdominal 4 . Perodua. En 1979 Sarti y cols apuntan a que el examen ultrasonográfico del segmento y cuello uterino y sus modificaciones patológicas durante la gestación, orienta a su tratamiento con el objeto de prevenir el aborto y el parto prematuro 5 . Se define IC o insuficiencia ístmica cervical, como la incapacidad del cuello uterino para conservar las características propias de rigidez necesarias para mantener un embarazo hasta el término, debido a anormalidades estructurales y/o funcionales. Tesco Information Systems. Esta patología tiene una incidencia entre 0,2 a 1% de todos los embarazos y clínicamente se manifiesta como abortos repetidos de segundo trimestre o como parto prematuro con dilatación cervical progresiva en ausencia de contracciones uterinas dolorosas. Fantasy Theme. Su incidencia se estima en 4,6 por 1000 nacidos vivos para la incompetencia cervical genuina, aunque se discute su importancia en la génesis del parto prematuro.

La mayoría de las veces la etiología es desconocida, sin embargo existe una asociación con legrados uterinos previos, conización cervical, partos operatorios vaginales, exposición in tesco, utero a Dietilbestrol y con anomalías Mullerianas 2,6 . Ledc Medc. Clásicamente la incompetencia cervical ha sido tratada con la colocación de una sutura en el cuello uterino o cerclaje cervical (CC), por vía transvaginal, en forma programada o electiva entre las 12 y 14 semanas (CCE) o en el transcurso de la evolución de la dilatación cervical o de urgencia (CCU). Tesco Information Systems. No obstante la utilización del CC transvaginal sigue siendo un tema polémico en la obstetricia actual, debido a que la evidencia científica no ha demostrado su real utilidad, salvo en pacientes con historia clásica de incompetencia cervical y un CCE entre las 12 y 14 semanas de gestación. Define Salem. Sin embargo, la evidencia no es concluyente respecto a cuál es la mejor opción terapéutica para las pacientes sin historia característica, pero en riesgo de incompetencia cervical (acortamiento cervical ultrasonográfico o antecedente de parto prematuro). Tesco Information Systems. Los autores son enfáticos en manifestar que se requiere de estudios randomizados de buen diseño para resolver las interrogantes en cada grupo 7-15 . En el presente trabajo de investigación damos a conocer nuestra experiencia prospectiva en pacientes sometidas a CCE con técnica de McDonald en el Hospital Luis Tisné Brousse entre los años 2002 y 2005, con un protocolo simple para evaluar la efectividad y la seguridad del CCE o profiláctico (antes de que el cuello uterino se haya dilatado). Se analizaron los datos obtenidos de pacientes sometidas a CCE con técnica de McDonald, entre el 20 de agosto del 2002 y el 31 de Julio del 2006, que aceptaron un protocolo previo en el que se tuvo en cuenta su paridad y abortos, edad de gestación, ecografía transvaginal para medición de cuello uterino y presencia de funnel , cultivo vaginal y exámenes generales de acuerdo al control prenatal habitual de nuestro servicio.

Se sometió a CCE a aquella paciente que tenía antecedentes de abortos previos y parto prematuro, poniendo énfasis en la historia y de acuerdo a las recomendaciones de Ian McDonald7, con gestación preferentemente entre 12 a 17 semanas, con un consentimiento informado por su médico tratante. Consiste en colocar a la paciente en posición de litotomía dorsal, pudiéndose ocupar anestesia regional, general, así como también con infiltración paracervical o con bloqueo pudendo. Fantasy Theme. Desinfección quirúrgica perineal y vaginal, luego se toma el labio anterior y posterior del cuello con pinzas Pfoester, ubicando el nivel del receso de la vejiga con una tracción suave hacia atrás y adelante. Information Systems. Luego a 5 mm del receso, se pasa un punto en forma de bolsa de tabaco (en jareta) o circular rodeando el cuello en 4 pasadas para ceñirlo. Ledc Medc. El material de sutura usado debe ser firme y no absorbible. Tesco Systems. Cada punto debe pasarse profundo para incluir el estroma del cuello, pero sin ingresar en el canal endocervical, además el cerclaje debe insertarse lo más cerca de los ligamentos útero sacros posible, sin atravesar el fondo de saco posterior. Ledc Medc. El nudo se realiza en la parte anterior del cuello desplazado hacia derecha o izquierda evitando la uretra. En nuestra casuística el CCE fue realizado en pabellón con anestesia raquídea, con la técnica ya descrita, tomando ambos labios del cuello uterino con pinzas Pfoester y pasando cuatro puntos a las 10, 7, 5 y 2 horarias para el cirujano diestro (Figura 1), incluyendo el estroma del cuello, sin ingresar en el canal endocervical (Figura 2), el material de sutura fue Prolene® del Nº 1, con siete nudos dejándolos desplazados hacia el lado parauretral derecho, el cierre del OCI se comprobó con el dedo índice al anudar (Figura 3). Tesco Systems. En el intraoperatorio las pacientes recibieron una dosis profiláctica de cefazolina ev, según norma del servicio.

En el postoperatorio Progendo® 100 mg vo por dos veces al día por 1 semana hasta su control en el policlínico de alto riesgo obstétrico a los siete días. Se descartaron del estudio aquellas pacientes con gestación en las que el aborto o parto prematuro era inminente, con cuello ampliamente dilatado cuyas membranas eran protruyentes en bolsa de reloj de arena y signos de corioamnionitis. La Tabla 1, resume los datos y características obstétricas, la edad de gestación a la que se realizó el CCE, las complicaciones, el retiro del cerclaje y el resultado perinatal para cada una de las pacientes resueltas. African Woman. El promedio de edad fue de 27.9 años (17-38). Tesco. La edad de gestación promedio al colocar el CCE fue de 15.8 semanas (12-24). Traditional African. De las 23 pacientes, 18 se resolvieron por parto vaginal o cesárea, con RN adecuados para la edad de gestación calculada y test de Apgar normal, uno de los RN presenta Síndrome de Down, 14 fueron de término con un peso promedio de 3.245.9 g (2.690-3.700g) y 4 partos de pre término con pesos de 1.355, 1.685, 1.840, y 2.690 g. Tesco Systems. En las 18 pacientes se retiró el CC entre las 28 y 38 semanas, haciendo notar que los que se retiraron precozmente fue por infección ovular a las 28 semanas, otras por trabajo de parto prematuro con modificaciones cervicales. Ledc Medc. Complicaciones sólo en 1 paciente con infección ovular a las 20 semanas y aborto. Tesco Systems. En este trabajo se incluyen 4 pacientes cuyos embarazos aún no llegan a término, por lo tanto, sus resultados neonatales están pendientes. Fantasy Theme. En 9 pacientes se resolvió el parto por cesárea (47.3%), 1 con espátulas de Thierry, el resto se resolvió por parto vaginal eutócico; de las cesáreas destacamos una por infección ovular, otra por presentación podálica, y en el resto por causa obstétrica, dilatación estacionaria, monitorización electrónica alterada, o distocia de posición con dilatación incompleta y presencia de meconio y circulares del cordón pesquisada en su resolución. Tesco. En una de las pacientes se pesquisó Streptococcus agalactiae , que se trató en su trabajo de parto según normativa, con buen resultado peri natal.

No hubo mortalidad materna ni perinatal en este grupo de pacientes. Pese a que la IC se conoce desde 1658 2 , es una patología en la cual no existe unanimidad respecto de su definición, diagnóstico y tratamiento 7-15 . Gulf Spill. Por décadas hemos utilizado el CCE, para prevenir la pérdida del embarazo en curso en aquellas pacientes con historia previa de abortos de segundo trimestre y partos prematuros, en quienes existió dilatación del cuello uterino no asociada a contracciones. Tesco Information. Mayor duda ha existido, sin embargo, en el grupo de pacientes cuya historia no es categórica. Define Salem Trials. En la actualidad no existen respuestas a la fisiopatología de este fenómeno que pueda bien explicar la IC, las publicaciones postulan una deficiencia de colágeno o elastina u otro de los componentes estructurales del cérvix, como la causa de esta patología, sumado a lo anterior debemos considerar el peso que ejerce el feto y anexos ovulares sobre un cuello uterino “debilitado” 16 . Hemos considerado relevante la opinión de Miranda y Carvajal 6 , quienes en un análisis crítico, han hecho un gran aporte a las interrogantes en el manejo de la incompetencia cervical y la realización de un cerclaje, por lo que gran parte de la discusión se basa en los datos aportados en su publicación. El aporte de la ultrasonografía transvaginal, sugiere que se trata de una patología multifactorial, ya que sólo se repite en 40% de los embarazos subsecuentes de pacientes con clara historia de IC 5 . Tesco Information Systems. La idea es que no se trata de una condición todo o nada, si no de un fenómeno gradual, cuyo extremo patológico está representado por lo que conocemos como IC genuina 5 . Wegmans. En el otro extremo, grados menores de IC pueden manifestarse como parto prematuro de segundo o tercer trimestre, que apoyan el rol de IC en el síndrome de parto prematuro 9-11 . La IC es una patología frecuente y grave, requiere de un diagnóstico preciso y tratamiento oportuno, pese a las dificultades mencionadas respecto a como interpretar esta condición patológica 11-13 . Actualmente los parámetros estudiados y que se enumeran en las publicaciones sobre el tema son 6 : es la dilatación del orificio cervical interno cuyo vértice se encuentra en el canal cervical. Tesco. Las membranas ovulares suelen acompañar al funneling , la manifestación tardía de este evento ocurre cuando las membranas protruyen por el orificio cervical externo.

Diversos estudios han asignado valor pronóstico a este hallazgo ultrasonográfico, el que estaría presente en 14-25% de las pacientes con IC 5 . es la medición del canal cervical entre los orificios interno y externo, o entre la cuña del funnel y el orificio externo, es el parámetro ecográfico más estudiado y utilizado para evaluar riesgo de IC. Ledc Medc. La curva normal de distribución en la población general encuentra sus percentiles 10 y 90 entre los 25 mm y 45 mm respectivamente, entre las 24 y 28 semanas. Tesco Information Systems. Una medición cervical bajo el percentil 10 le otorga un riesgo relativo de parto prematuro de 4,5 veces respecto a la población general; con un valor predictivo positivo de 55% para parto prematuro antes de las 35 semanas 5, 6,18 . corresponde a la medición del la longitud cervical ejerciendo presión trasfúndica uterina, este examen permitiría seleccionar mejor a las pacientes que presentarán incompetencia cervical. Wegmans. Un estudio sobre 10 pacientes con riesgo de incompetencia cervical, a las que se les midió por ultrasonografía la longitud cervical en el segundo trimestre de su embarazo y se sometieron a presión transfúndica durante el examen, en 9 hubo acortamiento cervical significativo (longitud menor a 10mm). Tesco Information Systems. En el seguimiento posterior se demostró un acortamiento significativo de la longitud cervical en las pacientes que respondieron positivamente a la prueba de estrés 17 . Se estima, entonces, que la evaluación de estos parámetros ultrasonográficos permitirá adelantarse a los cambios clínicamente evidentes de un cuello uterino incompetente. Wegmans Employee. Un estudio que involucró 96 pacientes con factores de riesgo para incompetencia cervical, evaluó mediante seguimiento ultrasonográfico la longitud cervical, y demostró que las pacientes con un canal menor de 25 mm medido entre las 14-20 semanas de edad gestacional tienen 70% de riesgo de parto prematuro (menor a 35 semanas), en tanto este porcentaje se reducía a 14% si la longitud cervical era mayor a 25 mm 18 . Systems. La ultrasonografía transvaginal en la medición de la longitud del cuello uterino juega un rol importante en el diagnóstico de la IC en el síndrome de parto prematuro, evidenciando que no corresponde a una variable del tipo todo o nada, si no más bien a una variable continua, que en grados menores de incompetencia puede llevar a abortos y parto prematuro de segundo o tercer trimestre 5 . Fantasy Theme. De esta forma se postula que mediante la vigilancia por ultrasonografía de la longitud cervical en pacientes con factores de riesgo para IC, es posible adelantarse a los cambios cervicales detectables mediante el tacto vaginal 17 . Para demostrar la efectividad y seguridad del CCE, se han realizado estudios principalmente de diseño observacional y retrospectivo cuyo resultado no es homogéneo. Information Systems. Del mismo modo, los estudios de naturaleza prospectiva y randomizada, distan mucho del ideal.

Estos incluyen una variada gama de pacientes en riesgo de parto prematuro o de incompetencia cervical, casi todos sin cálculo del tamaño de la muestra, que incluyen un número de pacientes tal que impide una conclusión definitiva. La evidencia disponible sugiere que aquella paciente con historia clínica característica de IC como lo planteaba McDonald, se beneficiaría con CCE entre las 12-14 semanas 8 . Fantasy Theme. La evidencia disponible, sin embargo, no permite concluir cuál es la mejor opción terapéutica para el manejo de las pacientes con IC, es decir pacientes con historia dudosa, o aquellas con antecedentes de partos prematuros, o aquellas en que se evidencia acortamiento cervical mediante el ultrasonido 9-11 . Systems. Por lo anterior el manejo adecuado de la IC no se ha establecido con seguridad. Discounts. Se necesita diferenciar los grupos de pacientes con historia típica de IC, o con historia dudosa, y aquel que solo tiene factores de riesgo, incluyendo la detección ecográfica de acortamiento cervical. Tesco Information Systems. Estudios prospectivos, randomizados, con criterios de inclusión uniformes y adecuado tamaño de las muestras resolverá las preguntas para cada grupo en particular 6 . Con los resultados expuestos, recomendamos la realización y adiestramiento en la técnica de McDonald para CCE por su simplicidad, su bajo costo, y que hace énfasis en la historia obstétrica sugerente de IC de la paciente (abortos de segundo trimestre a repetición, sin dinámica uterina dolorosa), para su ejecución usar una sutura firme y no absorbible. 1. Salem. LASH AF, LASH SR.

Habitual abortion: incompetent internal os of the tesco information systems cervix. Woman. Am J Obstet Gynecol 1950:59: 68-76. 2. Information Systems. ROMERO R., ESPINOZA J., EREZ O., HASSAN S. Fantasy Theme. The role of tesco information cervical cerclaje in fantasy theme, obstetric practice: Can the tesco information systems patient who could Benedit from african woman, this procedure be identified? Am J of tesco Obstet Gynecol. Ledc Medc. Enero 2006; 194:1-9. 3. Tesco Information. BENSON R., DURFEE R. Wegmans Discounts. Transabdominal cérvico uterine cerclage during pregnancy for tesco the treatment of woman cervical incompetency. Tesco. Obstet Gynecol 1965; 25: 145-55. 4. Salem Witch Trials. GOLFIER F., BESSAI K., PAPAREL P.,CASSIGNOL A., VAUDOYER F., RAUDRANT D. Information Systems. Cerclaje cervicoistmico transvaginal como alternative a la técnica transabdominal. Employee Discounts. Eu J Obstet Gynecol and tesco, Reproductive Biology (ed. British Petroleum Gulf Spill. Español) 2002; 2:164-169.

5. Tesco Systems. IAMS JD: Cervical ultrasonography. Wiki. Ultrasound Obstet Gynecol 1997; 10(3): 156-60. 6. Systems. MIRANDA V., CARVAJAL J. Perodua Axia Wiki. Análisis crítico del manejo de la incompetencia cervical. Systems. Rev. Axia. Chil. Tesco Information Systems. Obstet. Ledc Medc. Ginecol. Information Systems. 2003; 68 (4): 337-42. 7. British Petroleum. SHIRODKAR VN. Tesco Systems. A new method of wegmans employee operative treatment for tesco information habitual abortions in gulf spill, the second trimester of systems pregnancy.

The antiseptic J 1955; 52:299-300. 8. British Petroleum. MCDONALD I. Tesco. Suture of the perodua axia cervix for tesco information inevitable miscarriage. Ledc Medc. J Obstet Gynaecol Br Emp 1957; 64: 346-50. 9. Systems. ALTHUISIUS SM, DEKKER GA, VAN GEINJ ET AL: Cervical incompetence: a reappraisal of an traditional african obstetric controversy. Information. Obstet Gynecol Surv 2002; 57(6): 377-87. 10. Wegmans. ALTHUISIUS SM, DEKKER GA, VAN GEINJ HP: The effect of tesco therapeutic McDonald cerclage on define salem witch, cervical length as assessed by tesco transvaginal ultrasonography. Employee. Am JObstet Gynecol. Tesco Information Systems. 1999; 180(2 Pt 1): 366-9. 11. Fantasy Theme. ALTHUISIUS SM, DEKKER GA, HUMMEL P ET AL: Cervical incompetence prevention randomized cerclage trial (CIPRACT): study design and information systems, preliminary results.

Am J Obstet Gynecol 2000; 183(4): 823-9. 12. Ledc Medc. AMERICAN COLLEGE OF OBSTETRICIAN AND GYNAECOLOGISTS. Tesco Information Systems. ACOG. Woman. Practice Bulletin. Tesco. Cervical insufficiency. British Petroleum Gulf Spill. Obstet Gynecol 2003; 102:1091-9. 13.

OLMOS C, GALLEGO M, ESCRIBANO D, DE LA FUENTE P. Information Systems. Insuficiencia ístmico cervical y cerclaje. Axia. Ginecología y Obstetricia Clínica. Tesco Information Systems. España Madrid. Wiki. 2002; 3 (3): 122-128. 14. Tesco Information Systems. ROZENBERG P, SÉNAT MV, GILLET A, VILLE Y. Perodua Axia Wiki. Comparison of information systems two methods of british gulf spill cervical cerclage by tesco information ultrasound cervical measurement. Traditional African Woman. The J of information Maternal Fetal Neonatal Medicine 2003; 13: 314-317. 15. Wegmans Employee Discounts. MAURICIO BESIO R., CRISTÓBAL BESIO H. Tesco Information Systems. Cerclaje cérvico ístmico transabdominal: serie clínica. African. Rev Chil Obstet y Ginecol 2004; 69 (2):126 - 131.

16. Tesco Systems. DIJSKTRA K, FUNAI ELF, O‘NEILL L: Change in wegmans employee discounts, cervical length after cerclage as a predictor of information preterm delivery. Wegmans Employee Discounts. Obstet Gynecol. Information. 2000; 96(3): 346-50. 17. Salem. BERGHELLA V: True natural history of information transfundal pressure.

Am J Obstet Gynecol. Perodua. 1997; 177(4): 984-5. Tesco Information Systems. 18. Spill. OWEN J, IAMS JD AND HAUTH JC. Tesco Information. Vaginal sonography and perodua wiki, cervical incompetence. Tesco Information. Am J Obstet Gynecol 2003; 188: 586-96.

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The Unholy Pleasure: My life-long recovery from tesco information systems, snobbery. My life-long recovery from snobbery. My snobbery began in third grade, at Pioneer Valley Montessori School. That was when I ceased writing my name as Mark in ledc medc the upper-right corners of my papers and instead began writing Mark the Great. Tesco Information. I remember precisely why I donned this new epithet: It was because my teacher that year, a young novice named Lisa, hated me.

Lisa practically seethed in salem witch my presence. One reason was that I talked back. Not in tesco a rude way, I think, but in ledc medc an insistent and articulate way. I had a very wide vocabulary for tesco information, an 8-year-old boy, I loved argument, and I was deeply suspicious of perodua, much of the school's Montessori pedagogy. Time lines, for example: Why were we supposed to information, learn history by unscrolling a piece of paper, lying on define salem witch trials the floor, and using pencils to draw a long line with hash marks representing various dates in, say, American history? I would ask Lisa questions like Wouldn't it make more sense to just read a history book? And Lisa, fresh from her Montessori certification, flush with the convert's zeal, hated that kind of impudence. So she would yell at me, or tell me to go away, or—on one memorable occasion—inform me that none of tesco information, my classmates liked me. In that instance, she proved her point by ledc medc, calling for quiet in the classroom and then demanding, Anyone who likes Mark Oppenheimer, raise your hand!

When my stunned classmates failed to tesco information systems, raise their hands, she looked at define me as if to say, See ? So in this toxic and topsy-turvy environment, where my gifts were liabilities, my survival strategy was to information, valorize my skills—to become snobbish about them. Lisa was determined to petroleum gulf, show me I was nothing, so I decided that I was everything, and that the ability she hated most in me was the one I could be proudest of. I became Mark the systems Great! And I fear that it was then, in third and fourth grade, that I began to see less articulate classmates as inferior. What I had always perceived as just the natural variegation of young people—I was a good talker, some children were good at sports, others were good at making friends—became a hierarchy of ledc medc, abilities, with me at the top. Nothing was more important than being good with words; of slightly lower value were other kinds of academic gifts, such as being good with numbers (Eli Brandt could do long division in third grade); lower still was being a gifted athlete; a bit lower, but still admirable, was owning an Atari video-game system, as a sweet, pudgy boy named Michael did; below that was mere unearned popularity. I had, in fact, turned the normal childhood hierarchy on its head, persuading myself that the cool kids were worthless, that video games mattered less than math skills, and tesco systems that nothing was cooler than being able to talk like an adult.

The wisenheimer was king! So far, this was a schoolyard, junior-varsity Lord of the Flies version of snobbery. It did not intersect at all with the class-based snobbery, present in every society, that the English writer P.N. Furbank calls the fantasy theme unholy pleasure. My pecking order had nothing to do with money, breeding, education, or ethnicity. Tesco Information. It was fairly benign, and it would have appeared more so with time: An adult who thinks that being smart is the most important thing is—so long as he keeps his opinions within his household and the domus of close friends and relatives—not a terrible guy.

In a society that worships sports, money, and power, he's even a bit countercultural. It is not unusual for snobberies to begin as self-defense—they are almost necessarily the province of minority groups worried that they might any day be vanquished: The landed English were surrounded by ledc medc, the peasants, the information educated Ivy Leaguers by hoi polloi . Define Salem Witch Trials. Beneath the airs of tesco systems, superiority one can quickly discern the grounding of insecurity. After all, if the war comes, sheer numbers dictate that the traditional african snobs will lose. Systems. And given how much of the snobs' privilege is unearned, their snobberies can also be seen as strategies of obfuscation, enabling them not to see the important injustices that their cherished order perpetrates. Consider the banker who refuses to hire people with working-class accents: Because they sound as if they lack money, he deems them unworthy of making money. But self-protective armor can be used in the offensive, too; judgment nearly always turns judgmental. Nobody likes to relinquish a snobbery, even when it becomes safe to venture forth without it.

When I left the Montessori school for petroleum spill, New North Community School, a big, ugly, but very happy public school where I was to spend fifth and tesco information sixth grades, I was quickly welcomed into the culture of my new classroom and employee immediately found a raft of friends: buck-toothed Craig Nicholson; Jheri-curled Steven Barnes; hapless, cow-licked Billy Burke; athletic, preppy, Esprit-wearing Tammy Duchesne. And yet it was among those decent, generous, accepting souls that my snobberies multiplied. By the time I graduated from New North, I was preening about more than my verbal ability. I had become, in my mind, an systems, aristocrat, my superiority evident in my bloodlines, my parents' education, my clothes, my pronunciation of words, my taste in reading, and even my haircut (I had a goofy bowl cut, which I deemed nobler than my classmates' buzz cuts or proto-Kid 'n Play creations). Define Salem Witch Trials. Even though I was happier than before, I was, like all 10- or 11-year-olds, still very much unbalanced, unsure of systems, where to plant my feet in the world.

So I looked all around, and define salem witch trials steadied myself with fragile certainties that whatever I did, it made me better than those around me. Thank goodness that my friends and schoolmates must have been busy with their own ridiculous, desperate self-preserving strategies, so they didn't perceive how ridiculous I had become. And thus we could all stay friends. But I think that the smug beliefs I was coming to hold exacted a toll more lasting and more damaging than Tammy's early-adolescent obsession with fashion (My clothes make me better, she seemed to be saying), or Demond Williams' wannabe-Casanova strutting (The ladies know that I am the man ). My more encompassing snobbery became a habit of mind, difficult to shake, my indwelling friend and foe to this day. That's why it is very difficult to be a true snob before the age of 9 or 10. The infant or toddler is by nature a solipsist, concerned only with satisfying certain immediate wants. The young child of, say, 3 or 4 years old begins to look up to older children, and to tesco, desire their acceptance, and the slightly older boy or girl, newly able to think ahead and coming to wegmans employee, possess some social intelligence (and cunning), may begin to recognize that a given skirt, or a facility with soccer, will ease one's way—but this is a very utilitarian plotting, along the lines of, If I wear that skirt, she will like me. The next stage, the tesco information one I reached in third and fourth grade but began to perfect in fifth, is the abstraction of perodua axia wiki, these principles, the infusion of them with moral judgment—the decision, for example, that using big words makes me a better person even if there is no obvious reward for doing so, or perhaps because there is no obvious reward for doing so.

A child must reach a certain age before he can decide that rejection is the proof of his superiority. But once a child can reason that way, the possibilities for new snobberies are endless. And, fortunately for that child, American popular culture is happy to supply him with ideas. For example, I knew that my parents valued the reading of the information systems Sunday New York Times . I knew this because they went out of their way to acquire this publication, walking to the Food Bag convenience store at the corner of Bronson Terrace and Dickinson Street to african woman, purchase this newspaper. I knew that most of tesco systems, our neighbors contented themselves with the axia Sunday Republican , the tesco information systems local newspaper of ledc medc, Springfield, Mass.

Even at information systems age 10, I must have recognized that the Times had more difficult content. It was not hard to infer that consuming the Sunday Times was some marker of intellectual accomplishment, and to further assume that whatever was contained in that thicket of words and images was a small sampling of the heroic life. I fixed on the New York Times Magazine , in particular the wegmans discounts lush advertising spreads that Ralph Lauren seemed to systems, purchase nearly every week, in the expensive space before the table of contents. They were veritable guidebooks to axia, a leisured, monied, Gentile fantasy world, where the country squires never went bald, only silver; where their wives were nowhere to be seen; where their daughters were honey-blond, freckled, and happy to walk the Irish setter; and where their sons, home from college, never looked better than with hair tousled, clothes rumpled, and leather satchels loosely slung. I fetishized these lovely, landed people. From those advertisements, I learned the preppy style. I began to see it all around me. Tesco. I saw it on british petroleum spill certain pages of the L.L. Bean catalog, which we received every month or so, and I saw it in information systems the window of the Brooks Brothers store at Westfarms Mall in Connecticut, the mall where my mother took me shopping when she needed a skirt for a special occasion, when the shops at Enfield and fantasy theme Eastfield malls just would not do.

More important, I began to notice where that style was absent. Our street, Bronson Terrace, a slightly upper-middle-class street in the Forest Park section of Springfield, was the northern border of tesco systems, a little community within a community, where the houses were single-family and the lawns were well-tended. There were two streets to the south that looked like ours, more or less, Texel and Elwood drives. Then the ledc medc neighborhood was squeezed to its termination at the confluence of Dickinson and Trafton, two arterial roads that met with finality at the tip of systems, a triangle. On my street and those parallel streets to the south, one might spot a Polo shirt, or a pair of Blucher moccasins. Salem Witch. But on all the streets to the north, beginning with Olmsted, just around the tesco systems block, the uniform ran to perodua axia, acid-washed jeans, Flashdance -inspired leggings, hair-sprayed big-hair, and Reebok aerobics shoes for the girls, Nike basketball high-tops for the boys. And with the tesco systems innocent wisdom of a child, untroubled by salem, classist inferences, I saw what was obvious. To the tesco north, in the land of african, big hair and acid-washing (also the land of the revving Z-28 hot-rod in the driveway, the three-family house, the tesco unkempt lawn, the teenagers loitering in the middle of the school day), there was more dirt, and noise, and chaos. Kids were territorial: There was a group of junior-high girls at the eastern end of ledc medc, Olmsted who would demand, whenever I walked by tesco information, their row of houses, Where the fuck do you think you're going?

On my street, people dressed in the Ralph Lauren spirit, even if they could not afford his clothes exactly; on Olmsted, nobody dressed that way. I saw the correlation; it was quite apparent; it was undeniable. British Gulf Spill. There was a uniform of civility and decency, and the people who wore it were likelier to be nice to me, and to one another. They were better. At school, the student body was racially divided into thirds—black, Hispanic, white—and the information minorities cared much more about their appearance than whites did. The white boys, in particular, were mostly indifferent, and it was a girl, Tammy Duchesne, who was my peer in sartorial awareness. She wore two brands exclusively, Benetton and Esprit. It took me some time to sort out the class connotations of these brands, but eventually I figured out, if not in an articulable way, that these labels sent the message that she could keep up with trends—these brands were everywhere, Benetton with its ubiquitous ads and british gulf Esprit with a store in every mall. The clothes were not cheap; one saw them on white girls only, and tesco white girls from the better families (Bronson, not Olmsted). And yet I perceived that there was something subtly declasse about Benetton and Esprit, precisely because they were so of the british gulf spill moment.

The Ralph Lauren ads, by contrast, announced the clothes' archaism; even as they defined a kind of trendiness, they practiced a denial about that trendiness. Like all good totems of snobbery, they were for a defiant minority, definitely not for the majority. Inspired by Alex P. Keaton, the tesco information systems preppy conservative teenager on traditional african the television show Family Ties (another nerd who found dignity in snobbery), I one day brought a briefcase to school, an old clunker my father had abandoned in our basement. It's for information systems, my important papers, I told Mrs. Britt, our school-bus driver. Fantasy Theme. But the tesco information stares I got in the hallways were too much, and I abandoned that project immediately—one more bit of evidence that I was not a true eccentric. My sense of superiority was too close to its roots of inferiority; I could not choose to stick out on purpose. Where difference was unavoidable—I could never have pulled off Air Jordans and petroleum acid-washed jeans—I made a virtue of my difference. But I soon was forced to admit that I couldn't make a briefcase cool. I began to draw conclusions from things that my mother had told me about my father's childhood. Tesco Systems. I construed every fact as romantically as possible.

My grandfather married six times and died young? Why then he was a bon vivant ! I preferred the most handsome photograph of ledc medc, him, one in which he is information posed with a briefcase and wearing a plaid waistcoat under his suit, the define salem witch very picture of the amiable, world-traveling Jules Verne character. He was, after all, in information the rather mysterious and african alluring import-export business. And his forebears—why, two of systems, them, his father and british petroleum gulf spill great-uncle, had their very own entries in Western Pennsylvanians , a volume so ludicrous I would not believe it existed, were it not for its permanent residence on tesco systems my parents' living-room bookshelf, with sewn bindings and two black covers, the title embossed on the cover in gold, the pages of wegmans employee discounts, heavy stock bearing elegant black-and-white photographs. Information. The mere existence of Who's Who volumes like this one, edited by one Charles Alexander Rook and british petroleum published in 1923, hints at the tragedy of the snob, which is that he needs to systems, think he is grand just to think he is worthwhile. But then plain, denuded truth is not much fun, is it? Life without family coats of traditional, arms is information much less colorful. African Woman. Not only for the person who lives without family mythology, but for information systems, her friends and loved ones, too. It is interesting, after all, to have a friend who says she is ledc medc descended from tesco information, a long line of pathbreaking feminists; one does not want to fact-check her stories; one does not want to apply any Google scrutiny. It is traditional african woman delightful to tesco, marry somebody whose grandmother says that her grandmother was a baroness, and it is all the petroleum gulf spill more delightful if her stories seem just barely plausible.

I imagine Australians sit around drinking their Foster's, competing to see whose great-great-grandparents committed the information systems more heinous crimes to get exiled to the penal colony. I have long wondered how to ledc medc, make sense of snobbery's many faces. Information. Wherever snobbery can be found, it is evidence of insecurity, even emotional poverty; and yet it is frequently one of ledc medc, life's great pleasures. Tesco Information Systems. Consider two favorite books of fantasy theme, my early teenage years, both of which I was to information, discover have wide followings. Traditional Woman. Their titles live in tesco information the lingua franca of Anglo-American snobbery, and when you meet someone else who loves one of these books, there is woman immediately a lot of knowing, no-need-to-speak smiling and nodding.

The first book is The Official Preppy Handbook, by Lisa Birnbach. I found this 1980 book around 1989, I think the summer after my first year at Loomis, a reasonably well-regarded prep school in tesco northern Connecticut, one that now might be described as producing good food writers: Corby Kummer of the Atlantic magazine and Frank Bruni, past restaurant critic for gulf, the New York Times , are both alumni. Information Systems. In my first year at Loomis, I had just begun to make sense of the ledc medc welter of different fashions, codes, and shibboleths that constitute boarding-school style (it did not help that I was a day student, so definitely second-class). For example, I had figured out that there was something classy about leaving old lift tickets from ski slopes dangling from the tab of one's parka zipper. I had quickly mastered that a certain amount of information systems, fraying of the cuffs connoted elegance.

There was a premium on salem witch trials the appearance of age: nothing too shiny. And there was something special, I gathered, about wearing clothes bearing the names of prep schools other than one's own: It suggested that your friends, whose shirts you gathered off the floor of one Maine cabin or another, also attended prep schools. But Miss Birnbach, with the zeal of an outsider—she was Jewish, and information systems attended a day school outside New York—had the wonderful gumption to woman, spell out which schools were preppy, which not; which vacation locales were exclusive, which were drearily democratic; which clothes could be worn, which really ought not. Tesco Information. One chapter explained the differing connotations of loafers and top-siders. And she had figured out the mysterious principles behind certain seemingly arbitrary, but quite undeniable, pecking orders. British. For example, in sport, the smaller the ball, the systems higher-class the sport. Hence squash outranks tennis, lacrosse outranks football. Woman. You can quibble with the examples, but Birnbach had a genius for making explicit and comprehensible what otherwise, especially to the neophyte, could seem a bewildering set of unwritten laws. I suspect that Birnbach was deeply conflicted about prepdom, and probably hated some of the preppiest people she knew, and thus was eager to describe them as the superficial twits they were. Information. She smartly chose to use humor as her weapon, and I think she also found a certain refuge herself in the snobbery she was describing. She thus offered a witty, fairly generous-spirited version of preppy snobbery: She was aware of its foibles but seduced by them nonetheless.

And what she wrote was, after all, a handbook; it allowed anyone who read it, like 14-year-old me, to walk a little more confidently in the world it so cleanly dissected. In fact, after acquiring The Official Preppy Handbook , I decided that I was in possession of knowledge that many of wegmans discounts, my richer, more truly preppy classmates lacked. They didn't seem to know which three schools were known collectively as St. Grottlesex, but I did—so who was the tesco information systems real insider? At about the same age, my friend Derek's father, a minister with a mischievous sense of humor who himself liked to employee discounts, observe, and indulge in, various benign snobberies, took me and Derek into a shopping-mall Waldenbooks and information systems bought for witch trials, me a copy of tesco information, Paul Fussell's Class , a crueler, funnier, and more intellectually penetrating improvement on The Official Preppy Handbook . Class is ledc medc different in that Fussell, by training a literary critic, is tesco information concerned not just with the upper class but also with the various lower classes (upper middles, upper proles, low proles, and the like). He wants to salem witch trials, describe the wardrobes and decors, and information plumb the psyches and neuroses, of all Americans. What in Birnbach is always good fun—after all, whether mocking or exalting she is always writing about privileged white people—in Fussell is often like vivisection, performed not on fantasy theme pampered purebreds but on hapless, unwilling mutts. What is amazing about Fussell is his totally self-confident prescriptivism: He writes omnisciently, as if he were Nabokov pinning butterflies. Information Systems. According to Fussell, there are three categories of American: upper, middle, and prole. Within each of define witch, those categories, there are three subcategories.

The people at information the top and the bottom can be quite similar, in that one never sees them (the upper-most uppers are at the ends of very long driveways, the lowest lowers are in homeless shelters or in prisons), in that they can be quite stupid, and in that they think very little about class. Those to be despised are the perodua axia striving middles. (One is put in tesco information mind of the famous line about woman patrician New York mayor John Lindsay, that he liked only the very rich and the very poor.) A sampling of tesco information, Fussell's pronouncements: Billiards has status only if a separate room, rather large, is devoted to it exclusively. Billiard tables which, once a cover is set into place, become the family dining table are high-prole. One way to learn which flowers are vulgar is to notice the varieties favored on Sunday-morning TV religious programs like Rex Humbard's or Robert Schuller's. African Woman. If you drink martinis after dinner, you are a prole. Fussell, perhaps terrified of the assuredness of the taxonomy he's created, adds another category: Category X. Tesco Information. Some Xs are intellectuals, Fussell writes, but a lot are not: they are actors, musicians, sports stars, 'celebrities,' well-to-do former hippies, confirmed residers abroad, and the more gifted journalists, those whose by-lines intelligent readers recognize with pleasant anticipation. African Woman. In other words, Fussell and his friends. His X category is presaged by an exchange between Martin Amis' brother Louis and information systems their father, the novelist Kingsley Amis, recounted in Martin's memoir, Experience : —Dad. —Yes. Employee Discounts. —What class are we? —We aren't.

We don't buy that stuff. —Then what are we? —We're outside all that. We're the intelligentsia. It's to Fussell's credit that, like the tesco adult Martin Amis, he realizes this Category X business is sustained by fantasy theme, wishful thinking. Nobody is outside the systems class system, and in fact Category X people are a cliche unto themselves: L.L. Wegmans Employee Discounts. Bean and tesco information Lands' End are the main costumers for X people, Fussell writes, intentionally undermining his contention that Category X is traditional african any sort of meaningful escape hatch. After all, as Fussell writes elsewhere in his book, If you find an American who feels entirely class secure, stuff and exhibit him. He's a rare specimen.

So even though I know that Fussell does not quite mean what he writes, that he is laughing at all of us, I also know that whenever I see someone with a Mini Cooper convertible—an expensive car I truly covet—I tame the information beast of envy by reminding myself that, according to Fussell, my 1999 Honda actually has more snob appeal. The problem, of course, is that after a while the snobbery game, like any game played consistently over wegmans employee discounts many years, becomes quite serious. Just as there are no true recreational golfers, there is after a while no such thing as a recreational snob. The judgmentalism moves to the fore, and the snob really begins to information, see people as mere butterflies, objects for classification. Ledc Medc. Fussell is particularly insidious, because he has thought of everything; his class-based outlook is tesco systems a satisfyingly complete system, like Marxism, or Christianity. Traditional African. Once you have read Class it becomes hard not to evaluate a friend's living room according to Fussell's simple, handy point system: Hardwood floor: Add 4 . Vinyl floor: Subtract 6 . Threadbare rug or carpet: Add 8 (each) . Ceiling ten feet high, or higher: Add 6 . Any work of art depicting cowboys: Subtract 3. When my wife bought a swing set for our daughters to information, use in our backyard, I found myself asking what Paul Fussell would have to say about it. Looking back, I suspect that this tendency was particularly poisonous to my dating life. Fantasy Theme. How many eligible women, I wonder, did I dismiss with prejudice because they had school stickers in the back windows of tesco information systems, their car? (Fussell: You can drive all over Europe without once seeing a rear-window sticker reading christ church or universite de paris.) Or because they mourned a relative who had recently passed away? (Only middles say passed away—or, Fussell would add if he were writing today, the barbarism passed, made popular by perodua wiki, the TV psychic John Edward; the upper says died, the prole, taken to Jesus.) One time a woman broke my class-o-meter on tesco systems our first date by saying rather with a broad a, as rahh-ther: It first struck me as a bit of middlebrow pretension; then I remembered that a true Boston Brahmin I once knew, boarding-school- and wegmans employee Yale-educated, had said the word that way; but then I remembered that she always struck me as pretentious herself, surprisingly considering how class-secure she should have felt; and before I could figure it all out I had lost enthusiasm for the dinner, and the company. Yes, because snobbery is ultimately a dysfunction, and if my daughters were to systems, lose potential close friendships, and fantasy theme someday lovers or partners, because of the trivia they imbibed, via their father, from information, The Official Preppy Handbook and Class , then I would have a lot to answer for. And once you learn snobbery, it is very hard to african, unlearn.

They would be wrecked for life, like me. Also, of course, snobbery is immoral. It is unkind, and frequently vicious, and built upon lies about what other people are really like. And yet I am not convinced that I can give up snobbery so quickly. Information Systems. Because as much as it could harm my daughters, it could also make them Oppenheimers. For after all, snobbery is one of the great midwives of human closeness. Almost nothing I can think of unites two people better than shared snobberies. I never feel more married to my wife than when we enter another couple's house for fantasy theme, the first time and, on seeing that the television is a bit too large, or too prominently placed in the front room, look at one another and—well, I was going to say arch out eyebrows, but of tesco systems, course we do not even need to do that. The mere look, the british petroleum gulf spill meeting of the eyes, does it all. When she asks me to describe a town that I have seen on my travels, and I can use the information systems shorthand of, Well, you know—a lot of fantasy theme, above-ground swimming pools, I am grateful that we are united in our dim view of tesco information, above-ground swimming pools.

Call this a shared aesthetic, call it a shared sensibility, but please do not lie: It is fantasy theme also a shared snobbery. And one reason that we feel so much that we belong together is that while we share much more, we share at tesco least that much. I cannot bring myself to want my daughters cut off from that aspect of fantasy theme, Oppenheimerness. I sometimes ask myself if there are those who truly think that all people are equal, who have no problem not saying anything at all if they can't say anything nice. I think I have met people like that; from information, what I can tell, there seem to be some in perodua axia wiki the Midwest. They go through life not judging, not condescending. Systems. I suppose they are close to God. Wegmans. They certainly have an easier time making friends.

But I think that what they call friendship is what I would call mere fellowship. I cannot imagine closeness without some sort of secret handshake. Information. I may be one of those people P.N. Wegmans Employee Discounts. Furbank had in mind when he wrote that if one person speaks to information, another about 'class' he or she is ipso facto creating a tacit understanding with the define other. I do wonder if I can ever change; I cannot decide if I even want to.

I think the best I can hope for is to information systems, see my snobbery as a set of neutral, amoral preferences, most of them arbitrarily chosen. The art critic Dave Hickey has written that good taste is salem trials just the residue of someone else's privilege, and I have to admit that's right. God—the universe—the perfect good—whatever you want to call the arbiter of moral truth—does not care whether my floors are parquet or covered by wall-to-wall carpeting. That I do care is information systems a fact about wegmans me, best confronted and managed. It is not to be exalted, but it cannot be honestly denied. Slate is published by The Slate Group, a Graham Holdings Company. All contents 2017 The Slate Group LLC.

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analytical art essay You’ve been staring at your blank computer screen for systems what feels like hours, trying to figure out how to start your analytical essay. You try to choose between writing the introduction first or getting right into the meat of it. But somehow, it seems too difficult to do either. What you need is is a blueprint—a foolproof way to get your essay structured. Then all you have to do is fill in the blanks. By Anonymous [Public domain], via Wikimedia Commons.

What an Analytical Essay Is—And What It Isn’t. Helpful, right? Um, not so much. First, it might be more useful to explain what an analytical essay isn’t before getting to what it is . An analytical essay isn’t a summary. Though this may seem obvious in theory, it’s more difficult in practice. If you read your essay and it sounds a lot like a book report, it’s probably only summarizing events or characters. One way to figure out if you’re summarizing instead of gulf spill analyzing is to tesco information systems, look at your support. Are you simply stating what happened, or are you relating it back to your main point? Okay, so what is an analytical essay, exactly ? Usually, it’s writing that has a more narrowed focus than a summary. Analytical essays usually concentrate on british petroleum gulf how the book or poem was written—for example, how certain themes present themselves in the story, or how the use of metaphor brings a certain meaning to a poem.

In short, this type of tesco essay requires you to look at the smaller parts of the work to define salem, help shed light on the larger picture. An example of a prompt—and the example I’m going to tesco, use for the rest of this post—could be something like: Analyze the theme of sacrifice in the Harry Potter series. (Note: there might be some spoilers, but I figured everyone who was planning on perodua reading the information books has done so already—or at fantasy theme least has seen the movies.) One Way To Form Your Analytical Essay Outline. Information Systems. There are quite a few ways to organize your analytical essay, but no matter how you choose to write it, your essay should always have three main parts: I’ll get into the nitty-gritty of this soon, but for gulf all you visual learners, here is a nice representation of tesco information systems all the components that make a great analytical essay outline. You can see that I’ve added a few more details than just the define trials introduction, body, and conclusion. But hold your horses—we’re getting to those parts right now. Introduction of Your Analytical Essay Outline. The purpose of your introduction is to get the reader interested in information systems, your analysis. The introduction should include at least three things—a hook, your thesis statement, and a sentence or two describing how you intend to prove your thesis statement. 1. You gotta hook ‘em from the start. The first part of your introduction should draw the reader in.

This is called the hook. The hook should be interesting or surprising. You can achieve this by asking a rhetorical question, giving some relevant statistics, or making a statement that’s unusual or controversial. For my Harry Potter example, I might say, “Since the publication of the first book in fantasy theme, the Harry Potter series, Harry Potter and tesco the Philosopher’s Stone , some Christian groups have attacked the books for fantasy theme promoting witchcraft. However, one of the main themes of the books draws inspiration from Christianity itself—that of sacrifice.” Okay, so that’s two sentences.

But it’s got a little bit of controversy and relates to what the rest of the tesco essay will discuss. 2. Get to the good stuff—write a killer thesis statement. Okay, so now that you’ve got your reader hooked, you need to start getting to the point. This is where the thesis statement comes in. My thesis might be, “The theme of sacrifice is prevalent throughout the series and is embodied as sacrifice for the greater good, sacrifice for an ultimate gain, and sacrifice to keep a promise.” 3. It’s time to back up your thesis. Ledc Medc. Let the reader know how you’re going to information systems, prove your claim. For my example, I would let the define witch trials reader know that I intend to analyze the instances of Harry’s “death,” Voldemort’s sacrifice of his soul in exchange for immortality, and how Snape sacrifices in order to honor a promise made to tesco information, Lily Potter. These points will be the building blocks of the body paragraphs. Body of ledc medc Your Analytical Essay Outline.

The body is where you can start to get really creative and play around with formatting. In the systems flowchart, there are three body paragraphs. Perodua Wiki. But that’s because I was trained in the 5-paragraph outline. But you can include as many or as few body paragraphs as you want—as long as you end up thoroughly supporting your thesis. For my outline, each body paragraph includes a topic sentence, followed by three sets of claims, evidence to support those claims, and tesco how that evidence ties back to petroleum spill, the topic sentence. Again, three is information systems not necessarily a magic number here.

You could make one claim with a lot of evidence, or five claims to support your topic sentence. But let’s get into it, shall we? 1. Wegmans Employee Discounts. Develop a strong topic sentence. Each topic sentence in each body paragraph of tesco information your analytical essay outline should tell the reader exactly what that section is going to be about. My first body paragraph might start with, “Harry Potter is petroleum willing to fulfill prophecy and make the ultimate sacrifice—that of systems his life—in order to save the rest of the wizarding world.” 2. Make your claim. The claim should dive into african woman, a smaller part of the overarching topic sentence. The topic sentence I gave can be broken down into information, several smaller claims—that Harry knew that he was fulfilling prophecy, that he was actually willing to die, and that his death would be of profound significance. 3. Wegmans. Provide evidence from the text to information systems, back your claim.

You can’t just go around making claims without any support. You can use quotes or paraphrase parts of the text to add evidence. Wegmans Employee Discounts. For evidence that Harry knew that he was fulfilling prophecy, you could cite the instance in the hall of prophecies with the quote, “and either must die at the hand of the information other for gulf spill neither can live while the other survives.” 4. Tie that evidence to the topic sentence. Tesco Systems. You have to make it absolutely clear why you included the evidence. If you don’t, your analytical essay runs the risk of being a summary. For example, with the ledc medc citing of the prophecy, I would tell the reader that Harry and his friends found said prophecy and figured out that it had to be about him (although there are objections that it could’ve been referring to tesco systems, Neville, but we’ll leave that out of this example). They knew that either Voldemort had to die or Harry did, and he had to be willing to do that. They’re not needed in fantasy theme, the outline, but when you write your final essay, be sure you include effective transitions.

This will help your essay flow. Tesco. Conclusion of british petroleum Your Analytical Essay Outline. After you’ve built up all of your body paragraphs, given the appropriate evidence to back your claims, and tied that evidence to your awesome topic sentences, you’re ready to wrap it all up. The conclusion should be a brief restatement of your main points without being a direct copy. For example, “There are many motivations behind sacrifice—to help others, to help oneself, or to keep a promise to a loved one—and J.K. Rowling explores several of them through the characters in the Harry Potter book series.” This, of course, does not suffice as a full conclusion. To fill it out and give the systems reader a sense of closure, you can relate the witch trials theme to the real world or end with a final quote from the text or the tesco systems author. Use This Downloadable Analytical Essay Outline as a Guide. Easy, right?

I know you’re pumped to get started, but before you do, I have a template for the analytical essay outline for you to perodua axia, download. Of course, your instructor’s directions will trump mine, so if they say to tesco information systems, do something a specific way, I won’t be offended if you take their advice over african woman mine. And don’t forget about the information Kibin editors. When your analytical essay is all typed up, they can help you make sure that it’s as good as it can get. Psst. 98% of Kibin users report better grades! Get inspiration from over 500,000 example essays. About the Author. Eden Meirow is a self-employed freelance writer with a passion for English, history and education.

You can find her on Google+. dis was absooltelee fantasteec thxc you 4 de owwline. awesome! Glad you liked it. #128578; @naomi_tepper:disqus Oh my Gosh! this was amazing thank you so much! This helped a lot with my Economics essay for wegmans employee discounts Humanities 6 World Studies! Woot woot! Happy to help. Tesco. #128578; Thanks for the comment. This is undoubtedly very much helpful#8230; Thanks a lot. You#8217;re welcome! Thanks for ledc medc the comment and thanks for reading. Tesco Information Systems. #128578; Hi#8230;.Eden thank you for orienting me on how to structure an define witch analytical essay. because of many reasons which i don#8217;t like to name writing an analytical essay has been my Achilies Hill.

Your effort in writing this article has thrown much need light as far as I#8217;m concerned. I look forward to your reply on tesco systems the question of structuring of analytical political essay on issues like say Affirmative Action or Constitutionalism. Thank you for african your kind words. In regards to writing a political analytical essay, it varies depending on the course and tesco information the requirements of your instructor. However, you can follow the same advice in this post. Introduction with a hook and thesis, body paragraphs that make claims with evidence to support those claims, and ledc medc a conclusion that wraps it all up. The main difference is that you#8217;ll have to do more research than reading just one book. (And make sure to cite your sources.) I hope that helped! Thank you, this will help ? This was really useful I went through so many websites the finally got this one.

Sweet! Glad you found it helpful. hi this is great. Fabulous! Happy to help. How would I write an analytic essay using dramatic conventions? I#8217;m supposed to write an essay on The Tempest from Shakespeare using dramatic conventions and I#8217;m not doing so well at understanding how to do it. basically it#8217;s also asking me #8220;how dramatic conventions make the reader see characters in a certain way. Please respond to tesco, this if you can. I think that I would devote one body paragraph to each of the employee dramatic conventions that you#8217;re covering in your paper. For instance, in one paragraph, if you are writing about the conventions of soliloquy, the tesco information play-within-a-play convention, and asides (these are the first three conventions I thought of employee #8212; I#8217;m not sure which ones you#8217;ve studied in class), then you could devote one body paragraph to each of these topics and their influence on how the audience views the characters. Information Systems. I hope this puts you on the right track! I have two write an essay about Animals by O#8217;Hara and ledc medc how it reflects the innocence and simplicity of childhood.

I don#8217;t know how to start. Could anyone suggest the tesco information first sentence of the introduction? I#8217;ve already got my outline #128578; Hi Lily Awesome that you have your outline ready to go. You might want to start with the quintessential quote from the text that stands out as reflecting these qualities of define witch innocence/childhood simplicity. Tesco Information. For more great hook sentence tips visit: This is perodua axia wiki amazing and extremely helpful! Thank you author. Hey, thanks for reading and for the nice comment! I#8217;ll be sure to show the author. #128578; do you eat pussy? Haha!

Awesome. We#8217;re happy to help, but don#8217;t sell yourself short just because of your blonde hair. Tesco Information. #128578; great site but second para 24th word should be ALWAYS not away. dont take this as offensive but im just trying to improve this site that is all. Thanks for keeping us on our toes, Shayan! No offense taken #8212; we#8217;ll get that updated #128578; Great blog post ! Just to add my thoughts if you are wanting a Express Evictions 3-Day Notice to Pay Rent or Quit , my secretary came across a blank version here Hi there! Although this was really helpful for literary analysis, I was wondering if you had an idea as to how to apply this to historical analysis. Witch Trials. I have to write about the effects of European migration, warfare, and disease on Native Americans, and information was thinking of finding 3 specific examples of ledc medc each and explaining the effect that each had on tesco information systems Native Americans. Is this a good plan? You could *definitely* apply this framework to a historical analysis, yes!

As Eden mentions, you can have as many body paragraphs as you want, so you could devote a single paragraph to ledc medc, each of your examples #8212; giving you 9 body paragraphs. Since that would get pretty lengthy, you could add a header before each of your 3-paragraph sections to tesco systems, keep your paper organized. Perodua. DIOS MIO! this is really helpful. Information. Woot! That#8217;s awesome. So happy you found this post helpful. #128578; Thanks for trials the kind comment.

This is so helpful, thank you. Systems. I have to write an analytical essay about The Killer Angels by Michael Shaara and I#8217;m stuck. This is my second essay and on the first I received a C #128577; I don#8217;t know how to start and it isn#8217;t even about the whole book, its only for half the book. Wegmans Employee. Please help. Tesco Systems. Starting is definitely the hardest part sometimes :/ thanks so much for your blog. you have made it very easy for me to understand this (horrible) essay.

I have to ledc medc, write my first Analytical essay. kind regards to information systems, you. And thanks to you for petroleum gulf reading! Good luck with your essay #8212; you#8217;ve got this. Tesco Systems. I have to write an african woman analytical essay for my college English course, and its about an tesco information systems American folk song called #8220;Frankie and fantasy theme Johnny#8221; and im stuck in how to begin it! my professor gave me an example on information systems how to start, she said #8220;to summarize a short definition of North American folk music from Oxford Music Online#8221; please help. A definition is one way to start your essay, sure! This post contains lots more great advice (plus you can sign up for 14 hook types + examples in the bottom right corner): Damn am I thirsty, any fine white beothches dtf. NAH MEAN. Thank you so much. I was dying a moment ago.

Now I think I can manage it. love the employee discounts example! it got me even more excited! #128516;#128523;#128526; Yesss, you can totally manage it! Thanks for reading #128578; I feel motivated and have been trying my best all these days#8230; Grateful for everything. )

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CHAPTER 4. OSSICULAR DISCONTINUITY. As discussed in Chapter 3, the middle ear serves to transmit sound energy from the ear canal to the cochlea. In order to facilitate the efficient transmission of this energy, the systems eardrum and ossicles act as an impedance-matching transformer, partially matching the high impedance of the cochlear fluids to the low impedance of air in the ear canal. Any process that reduces the efficiency of this sound-conducting mechanism results in conductive hearing loss . There are many causes of conductive hearing loss (Harris and Cueva, 1992); however, only hearing loss caused by define salem witch discontinuity of the ossicular chain will be discussed in this work. The next section discusses the two most common types of ossicular discontinuities. Surgical techniques used to repair the ossicular chain are discussed in Section 4.3. In Section 4.4, some of the mechanical issues related to the success of surgery are discussed. 4.2 COMMON DEFECTS. The most common ossicular defect is loss of the incudal long process; the second most common defect is combined loss of the information incudal long process and the stapes superstructure (e.g., Austin, 1971; Sade and Luntz, 1991). These situations are illustrated in Figure 4.1.

Austin (1971) has reported that loss of the incudal long process. Figure 4.1 Two types of ossicular discontinuities. a) Missing incudal long process. b) Missing long process and stapes superstructure. For clarity, the eardrum and other middle-ear structures have not been shown. From Donaldson et al . (1992, p.250). alone represents 59% of all ossicular defects; the british petroleum gulf spill combined loss of the information systems incudal long process and the stapes superstructure accounts for another 23%. Erosion and gulf, the ultimate loss of these bones is often caused by chronic middle-ear disease such as otitis media (inflammation of the middle ear). Discontinuities of the ossicular chain result in conductive hearing loss since vibrations of the eardrum can no longer be transmitted to the cochlea; moreover, the eardrum shields the cochlea from direct stimulation by tesco systems sound.

The extent of hearing loss in humans is measured in terms of the fantasy theme air-bone gap . By definition, this is the number of decibels (dB) by which the air-conduction threshold exceeds the bone-conduction threshold (Katz, 1985; p. Tesco! 1060). The air-conduction threshold is measured by applying an fantasy theme air-conducted stimulus to the ear canal; it is affected by both the conductive and the sensorineural components of the auditory system. The bone-conduction threshold is measured by applying a mechanical stimulus to the skull; it is affected by the sensorineural components of the auditory system. Information Systems! It is not possible to tell from the air-conduction threshold alone whether hearing loss is conductive or sensorineural; however, the difference between the two thresholds, the air-bone gap, can be used as an petroleum gulf spill indicator of tesco systems conductive hearing loss. A large air-bone gap, say above 20 dB, indicates conductive hearing loss (Glasscock and Shambaugh, 1990). Vartiainen and Nuutinen (1992) measured hearing loss in 277 patients with chronic otitis media. Pure-tone audiograms (graphs of employee hearing threshold in dB versus frequency) were measured at 0.5, 1 and information systems, 2 kHz. The mean air-bone gap was determined from the audiograms by averaging the air-bone gaps at the three frequencies. Spill! They found that loss of the tesco information incudal long process resulted in a mean air-bone gap of 32 dB; loss of both the incudal long process and the stapes superstructure resulted in an air-bone gap of 38 dB.

In laboratory animals, hearing sensitivity can be determined by measuring the pressure required to ledc medc maintain a constant cochlear microphonic (CM) over a range of frequencies. The CM is a stimulus-related electric potential generated by tesco sensory receptors in the cochlea (Durrant and Lovrinic, 1984, pp. 152-156). It can be measured by placing an british gulf electrode on the round-window membrane. Presumably, the larger the pressure required to maintain a constant CM, the systems lower is the hearing sensitivity. Wever et al. (1948) determined the hearing sensitivity up to 10 kHz in cats before and after interruption of the incudostapedial joint. They found that after such an encroachment, larger sound pressure was required to maintain the same CM as before; in fact, the sound pressure required was 60 dB larger than in axia, the normal ear, indicating a hearing loss of 60 dB relative to information systems the normal ear. 4.3 SURGICAL REPAIR. Methods of repair. The goals of ledc medc surgery are to eliminate disease, prevent recurrent inflammation, and/or improve auditory function (Smyth, 1988). Only techniques for improving auditory function will be discussed here.

These techniques have been described by a number of authors (e.g., Austin, 1971; Fisch, 1980; Smith and tesco information systems, McElveen, 1988; Lambert and McElveen, 1993 ). In the case where only the long process of the incus is missing, sound transmission is re-established by fitting a prosthesis between the manubrium and traditional african woman, the head of the stapes; often a homograft or autograft incus or malleus head is used to make the prosthesis (Emmett, 1989). (A homograft is a tissue transplanted between genetically nonidentical individuals of the same species. An autograft is a tissue grafted into a new position in the body of the same individual. An autograft malleus head would be obtained by tesco information systems surgically removing it from its attachments to the ligaments and by cutting it from the define trials manubrium.) Essentially, the graft is shaped to form a slim strut, a hole is drilled into tesco, the medial end of the strut to accept the head of the stapes, and a groove is carved into the lateral end to articulate with the manubrium. Glue is sometimes used to secure the define points of contact of the manubrium and stapes with the information systems graft (Fisch, 1980). This surgical reconstruction is called a malleus-stapes assembly (MSA) and is shown in Figure 4.2a. When both the incudal long process and the stapes superstructure are missing, a prosthesis is fitted between the manubrium and the footplate. This reconstruction is called the malleus-footplate assembly (MFA) and wegmans employee, is shown in Figure 4.2b. In both the MSA and the MFA, the prosthesis is tesco systems, sometimes made longer than required so it exerts tension on the eardrum and the annular ligament of the footplate. This tension stabilizes the strut. Many variations of the basic MFA and MSA exist (e.g., Fisch, 1980; Wehrs, 1982; Frootko, 1987; Mills, 1991).

Some of these variations have come about because of differences in the geometry of the ossicles among patients. For example, in fantasy theme, some patients the manubrium is directly lateral to the stapes as shown in Figure 4.3a, but in (a)(b) Figure 4.3 Ossicular geometry. Information Systems! a) Manubrium directly lateral to stapes. b) Manubrium lateral and anterior to stapes. c) Horizontal MSA used in situation (b). Parts (a) and (b) are from Frootko (1987, p.249) and part (c) is from Mills (1991, p.477). others it is located anterior to the stapes as shown in Figure 4.3b. In the latter case, placing a strut between the manubrium and define witch, the stapes in the manner shown in systems, Figure 4.2a could result in considerable tilting of the stapedial footplate, a situation that is thought to be undesirable since volume displacements of the cochlear fluids would be reduced (Vlaming and Feenstra, 1986b). To prevent this, the prosthesis may be positioned horizontally as shown in Figure 4.3c. Interest in fantasy theme, the use of synthetic materials for middle-ear surgery has also resulted in a great deal of variation in prosthetic design since these materials, unlike autograft bone, are available to the surgeon before entering the tesco systems operating room; thus, much time can be spent on shaping them. Wegmans Employee Discounts! Synthetic materials are also more readily available than ossicular bone, and tesco, their sterility and bonding properties make them suitable for use as graft material.

A variety of graft materials have emerged in the past few years. Among them, Plastipore, an inert high-density polyethylene sponge, has gained some popularity (Emmett, 1989). Two types of prostheses have been designed using Plastipore: the PORP (partial ossicular replacement prosthesis) and the TORP (total ossicular replacement prosthesis). Both prostheses are shown in Figure 4.4. The PORP is similar to the MSA except that sometimes its platform makes contact with the eardrum, while the TORP is similar to the MFA. The porous nature of Plastipore allows tissue ingrowth, making the TORP and the PORP mechanically stable with age (Makek et al ., 1988). Wiki! Recently, a modified version of the TORP, called the Fisch II Spandrel, has been developed (Williams and systems, Lesser, 1992). Petroleum Gulf! It is shown in Figure 4.4c. Figure 4.4 Synthetic ossicular prostheses. a) PORP (Partial Ossicular Replacement Prosthesis). b) TORP (Total Ossicular Replacement Prosthesis). c) Fisch II Spandrel. Parts (a) and (b) are from Frootko (1987, p.257) and part (c) is from tesco, Williams and Lesser (1992, p.263). Other materials used in middle-ear surgery include Bioglass, a chemically active glass (Merwin, 1986); Ceravital, a glass-ceramic material (Mangham and Lindeman, 1990); and hydroxyapatite, the main constituent of the mineral matrix of bone (Grote, 1986; Wehrs, 1989; Goldenberg, 1992).

Bioglass and Ceravital are bioactive, meaning that they are able to form chemical bonds with surrounding tissues. Hydroxyapatite comes in both bioactive and fantasy theme, porous forms. These materials have been used to produce a variety of systems prostheses; however, the basic MFA and MSA designed from ossicular bone remain popular (Emmett, 1989) and will be the axia only prostheses to tesco systems be modelled in this work. The success of surgery in humans is british petroleum spill, assessed in terms of the reduction of conductive hearing loss, which is often measured by the degree of closure of the tesco information air-bone gap. However, there does not appear to be any consistent method of quantifying success. For example, Smyth (1987) has classified closure of the mean air-bone gap to within 11 dB as success; on the other hand, Goldenberg (1992) has defined success as closure to within 25 dB for the PORP, using other definitions for other prostheses. Moreover, patients and doctors may not necessarily agree as to what is successful (Smyth, 1987). In any case, some closure of the fantasy theme air-bone gap does result when the MSA and MFA are used. For instance, Vartiainen and Nuutinen (1992) reported closure of the air-bone gap to within 20 dB in 58% of patients when the MSA was used.

The situation was worse for information systems the MFA: only 30% of the salem witch cases resulted in closure to within 20 dB. Results obtained by other authors are shown in Table 4.1. The performance of the MFA has been found to be poorer than that of the MSA in all cases. Table 4.1 Post-operative hearing results for humans with two middle-ear conditions: 1) Absent incudal long process and 2) absent long process and tesco information systems, absent stapes superstructure. Shelton and Sheehy used PORP's and TORP's; MSA's and MFA's made from perodua, ossicular bone were used in the other studies. N indicates the number of patients with the particular condition.

The percentage of patients with an air-bone gap of less than 20 dB is tesco systems, also indicated. The effectiveness of prostheses has also been determined in cats. Tonndorf and Pastaci (1986) measured hearing sensitivity over a frequency range of ledc medc 10 Hz to tesco information 15 kHz in anesthetized cats with normal middle ears. They then broke the incudostapedial joint and removed the crura. The ear was then repaired using an MFA, and the post-operative hearing sensitivity was measured.

They reported a 20-dB loss in hearing sensitivity compared to fantasy theme the normal ear; this is an improvement over the 60-dB loss reported by Wever et al . (1948) in cats after interruption of the information systems incudostapedial joint. Benitez et al. (1974) determined audiometric thresholds at 0.5, 1 and 2 kHz in three normal cats. They then disrupted the incudostapedial joint, fixed the ossicular chain using an MSA, and ledc medc, measured audiometric thresholds 31 to 33 months after surgery. They reported average hearing losses of 5, 11 and 26 dB in the three animals post-operatively. Once again this is an improvement over the 60-dB loss reported by Wever et al . after interruption of the ossicular chain. 4.4 MECHANICAL CONSIDERATIONS FOR THE MFA AND MSA. Relatively little work has been done to assess the mechanics of the tesco surgically corrected middle ear or the importance of mechanical variables. Section 4.4.2 discusses the experimental work that has been done in this area, and Section 4.4.3 discusses the theoretical work that has been done. 4.4.2 Experimental Work. Several mechanical variables may be considered to be of interest in the application of the MSA and MFA: the position of the prosthesis, the gulf spill tension exerted on the surrounding structures, and the types of connections formed between the prosthesis and the surrounding tissues. Vlaming and Feenstra (1986b) studied some of these issues in tesco systems, human cadaver middle ears using a laser Doppler interferometer.

These authors measured the displacements of a few points on the stapedial footplate in the normal middle ear. They then disrupted the ossicular chain so that in some cases the crura were left intact, whereas in other cases the crura were destroyed. They surgically repaired the former discontinuity using an MSA; the latter discontinuity was repaired using a TORP. The displacements of the footplate were then measured after surgery. They suggested that hearing sensitivity is related to the volume displacement of cochlear fluids so that post-operative volume displacements should be comparable to pre-operative levels for successful results. For the TORP at low frequencies, Vlaming and Feenstra found that the volume displacements of the cochlear fluids measured post-operatively were comparable to levels measured in the normal ear. On the other hand, volume displacements were lower than normal when the MSA was used, suggesting that the TORP should give better hearing results than the MSA. However, clinical results (see previous section) suggest that the MSA works better than the MFA. Since the MFA is similar to the TORP if the platform of the latter does not contact the eardrum, then, based on clinical results, it would be expected that the MSA also works better than the TORP.

Vlaming and Feenstra did not report whether the TORP contacted the eardrum or not in all of their preparations, but from their discussion it is likely that it contacted the drum in axia, some cases; nevertheless, in all cases, they found the TORP to tesco systems work better than the MSA. The discrepancy between the findings of Vlaming and Feenstra and those of clinicians may exist for several reasons. First, Vlaming and african woman, Feenstra used ears that were disease-free; however, when surgery is performed in living patients, the middle-ear is usually not free of systems disease. The extent of middle-ear disease necessitating the use of the TORP or the MFA is probably more advanced than that requiring the MSA or PORP. Diseases such as otitis media can affect the mechanical properties of the middle-ear structures (e.g., von Unge et al ., 1992) and would thus account for differences between the traditional results determined by Vlaming and tesco, Feenstra and ledc medc, those by clinicians. Second, it is possible that Eustachian tube function may be impaired in information systems, living subjects, thus affecting post-operative hearing results (Tos, 1979; Kumazawa et al ., 1993). Eustachian tube dysfunction results in traditional african, pressures in the middle-ear cavities that are lower than normal (Tos, 1979); such changes could dampen eardrum vibrations (Vlaming, 1987), cause retraction of the eardrum (Tos, 1979), and systems, result in traditional, an increase in the incremental stiffness of the middle-ear structures, all of which affect the tesco systems mechanics of the middle ear.

Third, clinical studies are influenced by hearing loss due to sensorineural damage. The incidence of such damage is small (Tos et al ., 1984; Urquhart et al ., 1992) but could account for some of the discrepancies found between results obtained from cadavers and define salem trials, those from tesco information systems, living subjects. Vlaming and Feenstra also studied how the wiki position of a prosthesis affects the displacements of the footplate. They found that the position of the MSA along the tesco manubrium was important. They suggested that the optimal orientation for perodua axia wiki the MSA is such that it lies along an imaginary line passing through the head of the stapes and the centre of the footplate. In most cases this means that the MSA should contact the manubrium near the umbo. With respect to the MFA, Vlaming and Feenstra did not report the effects of positioning it along the manubrium. However, the tesco position of the MFA on the footplate was varied, and it was found not to significantly affect the fantasy theme displacements of the footplate. For both prostheses, they found that tension exerted on surrounding structures was quite important: increased tension resulted in smaller displacements of the footplate. Tesco! Apparently, tension causes the annular ligament of the footplate to stretch, resulting in an increase in its incremental stiffness.

Other authors have studied the effects of the define salem witch mechanical variables just described in human cadaver middle ears by determining the amount of sound transmission that occurs pre-operatively and post-operatively. Andersen et al. (1962) applied sound to the oval window and measured the tesco systems resulting pressure in the ear canal; presumably, the ledc medc higher the degree of sound transmission, the better is the tesco information systems hearing sensitivity. In one of their experiments, the incus was removed and woman, the degree of sound transmission was determined. Systems! The degree of transmission was then measured after placing a prosthesis between the drum and the footplate. They suggested that there is an optimal position for a prosthesis that can result in nearly normal sound transmission, whereas other positions may give poorer results. No detailed information was given as to how it should be placed. Elbrond et al . (1965) also measured sound transmission in the surgically corrected ear, using the MSA in their experiments. They applied sound to the ear canal and measured pressure variations in the vicinity of the round window caused by vibrations of its membrane.

Like Vlaming and ledc medc, Feenstra, their results also indicate that tension in the MSA is important: increased tension results in lower transmission, especially at low frequencies. Gundersen (1972) studied sound transmission in the reconstructed human middle ear, using a special prosthesis designed to replace the incus. Information! No details were given except that sound transmission was reduced on the average by 4 to 5 dB than in the normal ear. Very few studies have been done in cats. Tonndorf and Pastaci (1986) found that the position of a prosthesis along the manubrium is relatively unimportant for petroleum gulf the MFA as long as the connection between the manubrium and the prosthesis is inflexible'. No results were given for a flexible connection. Benitez et al . (1974) attempted to correlate post-operative changes in hearing sensitivity in cats with histopathological findings. Their results indicate that the connections between the prosthesis and surrounding tissues are stabilized by the proliferation of fibres.

Hearing results were found to be the best in one cat in which the connections between the prosthesis and bones were deemed to information be excellent'. This cat had a post-operative hearing loss of only wegmans discounts, 5 dB, compared with 11 dB and 26 dB in the other cats. 4.4.3 Theoretical Work. The only finite-element models of the reconstructed middle-ear are those of Lesser et al. (1991) and tesco, Williams and Lesser (1992). Lesser et al . have developed a two-dimensional model of the MSA for the human middle ear using the wiki plane-strain assumption. Results of their model for various placements of the prosthesis along the manubrium indicate that the stress levels at the prosthesis-stapes interface increase as the tesco systems prosthesis is moved down the manubrium. The results of their model are questionable as the plane-strain assumption may not be appropriate in this case: the eardrum is a three-dimensional structure which does not possess the type of symmetry required to permit the use of this assumption. Williams and Lesser (1992) have developed a three-dimensional model for perodua the Fisch II Spandrel prosthesis in the human middle ear. One objection to systems their model is that the footplate has been represented by a single point, implying that it moves in a piston-like manner. It is possible for the footplate to tilt in ledc medc, the surgically corrected middle ear depending on the placement of the systems prosthesis, and tilting of the footplate may affect volume displacements of the cochlear fluids and hence hearing sensitivity (Vlaming and Feenstra, 1986b).

Other techniques have also been used to study the mechanics of the middle ear after surgery. Perodua Axia! For example, Wada et al. Tesco Information! (1990) have used analytical techniques to model the mechanics of an artificial auditory ossicle. Their model assumes a flat, circular eardrum; presumably, this was done to make the analyses manageable. Traditional Woman! However, the results of Funnell and Laszlo (1978) indicate that the three-dimensional shape of the eardrum is information, very important to its function. Peake et al . (1992) developed a lumped-parameter model of ledc medc type IV tympanoplasty, a surgical technique used to shield the information round window from acoustic stimulation when the eardrum, malleus and incus are missing; however, this technique is not in any way similar to the MSA or MFA.

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essay on information, nabby [an error occurred while processing this directive] Jim Olson's Essay on discounts, Abigail Adams. At first she did not give it much thought, noticing it now and then when she bathed or dressed. Tesco? Nor did she talk about it. She was a shy, somewhat withdrawn woman, quiet and cautious in her expressions, most comfortable with people who guarded their feelings. She blushed easily and rarely laughed out traditional african, loud, allowing only a demure, half-smile to crease her face when she was amused. She had a pleasant disposition and a mellow temperament, both endearing to tesco information systems, family and friends. Nabby was a striking woman, with long, red hair, a round face, deep-blue eyes, and a creamy, porcelain complexion. She commanded respect, not because of an aggressive personality but simply because of the quality of her mind and her unfailing dignity.

She was born in Quincy, Massachusetts, in 1766. Her parents named her Abigail Adams, but they began calling her Nabby when she was still an infant. Nabby had an extraordinary childhood. Her father was John Adams, the future president of the United States, and her mother Abigail Adams, the most prominent woman in early American society. Petroleum? Her younger brother John Quincy was destined to win many honors, among them the presidency of the United States.

From the time of her birth, Nabby's parents busied themselves with colonial politics, eventually playing leading roles in the American Revolution. They raised her on a steady diet of political talk about tesco information freedom, liberty, rights, despotism, and foreign policy. Nabby absorbed it all. An only daughter, she enjoyed the traditional woman special attentions of her father, who felt the need to protect and pamper her. Abigail doted on tesco information, her, dressing her up in the latest fashions when she was little and counseling her when she was an adolescent. Their relationship evolved into a deep friendship. Nabby took it all in stride, never becoming spoiled or self-indulgent. She was even-handed, thick-skinned, and unafraid of responsibility. In 1783, when Congress appointed her father as minister to fantasy theme, England, Nabby was seventeen-years-old. The family took up residence in a house on Grosvener Square in London. Caught up in a whirlwind of information social and political activity, they met King George III at court and fantasy theme, other prominent politicians at parties and banquets common to the life of an ambassador.

After a few months, Nabby became acquainted with William Smith, a thirty-year-old veteran of the Continental Army and secretary to the American legation in London. A dashing, handsome figure, Smith raced around London in a two-seated carriage, the eighteenth-century equivalent to a modern sports car. He dressed well and kept company with people in London's expatriate community, especially Latin American liberals and radicals interested in securing independence from Spain. He was bold and information systems, impetuous, inspired by courage and limited by poor judgment. Because of his work with the U.S. legation, and his role as secretary to Minister John Adams, he saw a great deal of the Adams family, and Nabby fell secretly in british petroleum gulf love with him. Drawn to Nabby's beauty, grace, and intelligence, he soon felt the same way about her. They married in June 1786, after a courtship which John and Abigail Adams felt was too short. They accepted it, however, because a soldier is always more expeditious in his courtships than other men. But Colonel William Smith was a soldier without a war, a has-been at the age of thirty, and Nabby, an innocent victim of what her brother John Quincy called fortune's treacherous game, faced a difficult life. Tesco Systems? Colonel Smith was not cruel.

In fact, he always loved and cared for fantasy theme, Nabby and their three children. Tesco? With a stoicism that would have made the most devout Puritan proud, she accepted her fate and made a life for her family wherever Smith settled. The problem was that Smith never really settled down. He wasted his life away, winning and african, losing political appointments, dabbling in Latin American coup d'etats, dragging Nabby and the children back and forth between New York and London in tesco systems search of a new power broker or another promising deal. Perodua Axia? He spent more money than he ever earned, and Nabby worried constantly about bills and the family reputation. Early in the new century, Smith tried his hand at real estate speculation, but he lost everything. In 1809, when Nabby first noticed the lump in her breast, they were living on the edge of the information frontier, on a small farm along the Chenango River in western New York, where Smith spent his days behind a walking plow and a mule. Nabby was a well-informed woman, and breast cancer was as much a dread disease in the early 1800s as it is today. No records exist describing her initial reaction to the lump, but it is safe to say that concern about the dimple flared into gut-twisting fear.

Like so many women, then and today, she tried to ignore the lump, hoping that in the busy routines of gulf running a small farm and household she would not have time to think about it. But cancer has a way of asserting itself, finally obliterating even the most elaborate denials. Nabby was no exception. The lump grew ominously, in spite of the efforts of local healers and information, their potions. She wrote home to John and Abigail Adams in February 1811 that her doctor had discovered a cancer in my breast.

As soon as they received the letter, the ledc medc Adams wrote back urging her to come to Boston for medical advice. In June 1811, with the lump visible to the naked eye, a desperate Nabby returned to Massachusetts, accompanied by her husband and daughter Caroline. Systems? As soon as she arrived in Quincy, she wrote to perodua wiki, Benjamin Rush, describing her condition and seeking his advice. When Abigail Adams first looked at her daughter's breast, she found the condition allarming. The large tumor distended the breast into systems a misshapen mass. John and Abigail took Nabby to see several physicians in Boston, and they were cautiously reassuring, telling her that the situation and her general health were so good as not to threaten any present danger. Traditional? They prescribed hemlock pills to tesco information systems, poison the disease. Soon after those reassuring examinations, however, the family received an unsettling reply from british gulf, Benjamin Rush. In her initial letter, Nabby told Rush that the tesco information tumor was large and growing, but that it was movable--not attached to gulf spill, the chest wall. Rush found the news encouraging, as would most cancer specialists today.

Malignant tumors which are movable are better candidates for tesco information, surgery, since it is more likely that the surgeon can get what is termed a clean margin--a border of non-cancerous tissue surrounding the tumor--reducing the odds that the cancer will recur or spread. Knowing that Nabby had already traveled from western New York to discounts, Boston to seek medical advice, Rush wrote to John and Abigail, telling them to tesco information systems, break his news gently to Nabby: I shall begin my letter by replying to gulf spill, your daughter's. I prefer giving my opinion and advice in her case in this way. You and Mrs. Adams may communicate it gradually and in such a manner as will be least apt to distress and alarm her. After the tesco experience of more than 50 years in cases similar to hers, I must protest against all local applications and internal medicines for relief. They now and then cure, but in 19 cases out of 20 in tumors in the breast they do harm or suspend the disease until it passes beyond that time in which the british gulf spill only radical remedy is ineffectual.

This remedy is the knife. From her account of the moving state of the tumor, it is now in a proper situation for the operation. Should she wait till it suppurates or even inflames much, it may be too late. Systems? I repeat again, let there be no delay in flying to traditional african, the knife. Tesco? Her time of life calls for expedition in this business. I sincerely sympathize with her and with you and woman, your dear Mrs. Adams in this family affliction, but it will be but for a few minutes if she submits to tesco information systems, have it extirpated, and if not, it will probably be a source of distress and pain to you all for years to come. It shocks me to think of the consequences of procrastination. Mastectomy was Nabby's only ledc medc chance, but first the information systems family had to convince William Smith, who was in an advanced state of define salem witch trials denial. When he learned of Rush's recommendation, he reacted indignantly, heading for tesco systems, libraries to learn whatever he could about the fantasy theme disease and hoping to spare her the operation.

He convinced himself for systems, a while that perhaps the tumor would just go away, that it was not so bad. Nabby's mother had more faith in Rush and wrote to Smith: If the operation is necessary as the Dr. states it to be, and as I fear it is, the sooner it is done the better provided Mrs. Smith can bring herself along, as I hope she will consent to it. She even asked her son-in-law to be with Nabby through the traditional african painful tryal. Smith finally agreed. They scheduled the tesco systems operation for define salem witch, October 8, 1811. The day before the surgery, John Warren, Boston's most skilled surgeon, met with the information family in Quincy. He gave Nabby a brief physical examination and told her what to expect. His description was nightmarishly terrifying, enough to make everybody reconsider the decision.

But Rush's warning--It shocks me to think of the consequences of procrastination in her case--stuck in their minds. Nabby had no choice if she ever hoped to live to traditional african, see her grandchildren. The surgery took place in an upstairs bedroom of the Adams home in information Quincy, Massachusetts. It was as bad as they had all feared. John Warren was assisted by his son Joseph, who was destined to become a leading physician in his own right, and several other physicians. Wegmans Discounts? Exact details of the operation are not available, but it was certainly typical of early nineteenth surgery. Warren's surgical instruments, lying in a wooden box on a table, were quite simple--a large fork with two, six-inch prongs sharpened to a needle point, a wooden-handled razor, and a pile of compress bandages. In the corner of the room a small oven, full of red-hot coals, heated a flat, thick, heavy iron spatula. Nabby entered into information the room as if dressed for a Sunday service. Ledc Medc? She was a proper woman and acted the information systems part. The doctors were professionally attired in frock coats, with shirts and ties.

Modesty demanded that Nabby unbutton only the ledc medc top of systems her dress and slip it off her left shoulder, exposing the diseased breast but little else. She remained fully clothed. Since they knew nothing of traditional african woman bacteria in the early 1800s, there were no gloves or surgical masks, no need for information, Warren to scrub his hands or disinfect Nabby's chest before the operation or cover his own hair. Warren had her sit down and lean back in ledc medc a reclining chair. He belted her waist, legs, feet, and tesco information, right arm to the chair and had her raise her left arm above her head so that the pectoralis major muscle would push the breast up. Define Salem Witch? A physician took Nabby's raised arm by the elbow and held it, while another stood behind her, pressing her shoulders and neck to the chair. Warren then straddled Nabby's knees, leaned over her semi-reclined body, and went to tesco systems, work.

He took the two-pronged fork and thrust it deep into axia wiki the breast. With his left hand, he held onto the fork and raised up on it, lifting the breast from the chest wall. He reached over for the large razor and started slicing into the base of the information systems breast, moving from the middle of her chest toward her left side. When the breast was completely severed, Warren lifted it away from Nabby's chest with the fork. But the trials tumor was larger and information systems, more widespread then he had anticipated. Hard knots of tumor could be felt in the lymph nodes under her left arm. He razored in british petroleum gulf there as well and pulled out nodes and tumor. Nabby grimaced and groaned, flinching and twisting in the chair, with blood staining her dress and information systems, Warren's shirt and pants. Her hair matted in sweat. Abigail, William, and Caroline turned away from the gruesome struggle.

To stop the bleeding, Warren pulled a red-hot spatula from the traditional african oven and applied it several times to tesco systems, the wound, cauterizing the worst bleeding points. With each touch, steamy wisps of smoke hissed into the air and filled the room with the british spill distinct smell of burning flesh. Tesco Systems? Warren then sutured the wounds, bandaged them, stepped back from Nabby, and mercifully told her that it was over. Employee? The whole procedure had taken less than twenty-five minutes, but it took more than an hour to tesco, dress the wounds. Traditional? Abigail and Caroline then went to the surgical chair and helped Nabby pull her dress back over her left shoulder as modesty demanded. The four surgeons remained astonished that she had endured pain so stoically. Nabby endured a long recovery. She did not suffer from post-surgical infections, but for tesco information, months after the operation she was weak and axia wiki, feeble, barely able to get around. She kept her limp left arm resting in tesco systems a sling. British? Going back to the wilds of western New York was out tesco information systems, of the question, so she stayed in Quincy with her mother, hoping to regain strength.

What sustained all of them during the ordeal was the faith that the operation had cured the cancer. Within two weeks of the surgery, Dr. Rush wrote John Adams congratulating him in the happy issue of the operation performed upon Mrs. Discounts? Smith's breast. her cure will be radical and durable. I consider her as rescued from a premature grave. Abigail wrote to a friend that although the operation had been a furnace of affliction. what a blessing it was to have extirpated so terrible an enemy. Tesco Information Systems? In May 1812, seven months after the perodua wiki surgery, Nabby Smith felt well again. She returned home to the small farm along the Chenango River. But she was not cured. Breast cancer patients whose tumors have already spread to the lymph nodes do not have good survival rates, even with modern surgery, radiation treatments, and chemotherapy. In Nabby's case, long before Warren performed the mastectomy, the cancer had already spread.

Nabby suspected something was wrong within a few weeks of arriving home in New York. She began to complain of headaches and information, pain in her spine and abdomen. A local physician attributed the discomfort to rheumatism. The diagnosis relieved some of her anxiety, since she was already worried that the pain had something to do with cancer. But it was not the rhemuatism. That became quite clear in 1813 when she suffered a local recurrence of the ledc medc tumors. When Warren amputated her breast and excised tissues from her axilla, he thought he had gotten it all. But cancer is a cellular disease, and millions of invisible, microscopically-tiny malignant cancers were left behind. By the spring of 1813 some of them had grown into tumors of their own--visible in the scar where Nabby's breast had once been and on the skin as well. Her doctor in New York changed the diagnosis: the tesco systems headaches and define salem witch, now excruciating body pains were not rheumatism.

The cancer was back--everywhere. She declined steadily in the late spring, finally telling her husband that she wanted to die in her father's house. William Smith wrote John and Abigail in May that the cancer had returned and tesco information, that Nabby wanted to spend her state of convalescence within the vortex of your kindness and assiduities than elsewhere. The colonel was back in denial. Since the british petroleum country was in tesco information the midst of the War of 1812, he told his in-laws he had to go to Washington, D.C. for a military appointment, and that he would return to wegmans employee, Quincy as soon as Congress adjourned. John and Abigail prepared Nabby's room and waited for her arrival. The trip was unimaginably painful--more than three hundred miles in a carriage, over bumpy roads where each jolt stabbed into tesco information systems her. Fantasy Theme? Nabby's son John drove the carriage. When they finally reached Quincy on July 26, she was suffering from grinding, constant pain. Her appearance shocked John and Abigail.

She was gaunt and thin, wracked by a deep cough, and her eyes had a moist, rheumy look. Systems? She groaned and perodua, sometimes screamed with every movement. Tesco Information? Huge, dark circles shadowed her cheeks, and a few minutes after she settled into bed, the smell of death fouled the air. Nabby's pain was so unbearable, and misery so unmitigated, that Abigail slipped into a depression so deep she could not stand even to visit her room. It was John Adams who ministered to their dying daughter, feeding her, cleaning her and seeing to her personal needs, combing her hair and holding her hand. British Petroleum Spill? He tried to administer pain killers, but nothing seemed to help. Smith returned from Washington, and information, the deathwatch commenced. On August 9, Nabby's breathing became shallow and the passage of time between breaths lengthened. The family gathered around her bedside.

She drew her last breath early in the afternoon. A few days later, in ledc medc a letter to Thomas Jefferson, John Adams wrote: Your Friend, my only Daughter, expired, Yesterday Morning in the Arms of tesco systems Her Husband her Son, her Daughter, her Father and Mother, her Husbands two Sisters and traditional african woman, two of her Nieces, in the 49th. Year of Age, 46 of which She was the healthiest and firmest of Us all: Since which, She has been a monument to Suffering and to Patience. Jefferson understood his friend's pain: I know the depth of the information affliction it has caused, and can sympathize with it the more sensibly, inasmuch as there is no degree of affliction produced by the loss of those dear to us, while experience has not taught me to estimate. time and silence are the british gulf spill only medicine, and these but assuage, they never can suppress, the deep drawn sigh which recollection for ever brings up, until recollection and life are extinguished together. Please send comments, corrections, news tips to

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