Admission to MBA Program Essay Example | Topics and Well Written Essays - 250 words

Admission to MBA Program - Essay Example This is important in my opinion because the workplace has changed in the last several years and it is more diverse. This calls for people who can understand each others differences while acknowledging that they must come together in order to complete a project. This is one of the places that active listening comes in because each part of the team must listen to the others in order to move foreword with a project. I believe that another strength is compassion that gives me the ability to look understand the needs of people and help them achieve their goals. When I think of weaknesses, my major weakness is that I am a perfectionist. Although many people may think this is a strength, for me it has a tendency to slow me down. As an example, when I work on a project independently I want to make sure that everything is the way I want when it is done. Because of this, I have often taken more time on a project that necessary. I am working to change some of my habits in this area so that I can move through projects faster and easier. The personal qualities I have include enthusiasm, charisma, empathy, keen observation, I am easy going and personable. I find these qualities becoming more important as I grow older and I understand the world of work better. I believe that these qualities also help me when I am working with teams or individuals. The characteristic I would like to develop is public speaking. I am nervous when I stand in front of a group for a presentation because I tend to be more introverted than extroverted. I would like to become more comfortable in front of groups. Finally, my main professional goal is to have an executive position with a Fortune 500 company. I feel that an MBA will put me into a position to find a company that will fit my talents and abilities. I feel that today, many companies are in need of qualified candidates and the MBA will be one way for me to realize my

Chirchill Response Paper Essay Example | Topics and Well Written Essays - 500 words

Chirchill Response Paper - Essay Example The reader debates the categorical use of such superlatives. Johnson is sometimes too kind to his subject: Churchill’s being a â€Å"Conservative, Liberal, Coalition, Constitutionalist, Unionist, and National Conservative† (15), is definitely the sign of a political opportunist and the author’s terming this â€Å"Churchill’s courage in crossing the floor† (15), is a little mild! Churchill’s foresight is remarkable. His â€Å"prophetic words --- spoken more than a dozen years before the catastrophe† (Johnson, 14) of World War I, show him to be a man of awesome intellect. Another instance of Churchill’s remarkable judgment is the case of communist Russia, when he attempts to reverse Lenin’s Bolshevik coup in 1917, and nip communism in the bud. Again, his failed attempts to convince FDR to decisively combat communism in the final stages of World War II, show that he is the only senior statesman of that time to fully appreciate the dangers of communism. Johnson provokes the reader to wonder whether the Cold War, and the atrocities of the Gulag, could have been avoided if Churchill had his way. Churchill is one of the first to realize the threat posed by Hitler. Churchill’s early investment in Middle East oil, through BP, is another case which demonstrates his prescience. Churchill is so completely identified with Britain in the period of war that it is a revelation to know that he was also an excellent peace time administrator. His welfare measures as President of the Board of Trade, and his prison reforms as Home Secretary, add to his stature. He is obviously an administrator par excellence. Britain definitely would not have had the navy and air force she did, if not for Churchill. Johnson’s inclusion of many of Churchill’s witticisms adds to the appeal of the book and ensures that the heavy parts are enlivened and the reader is never bored. Some gems: â€Å"I trod on the Prince of Wales’s toe,† he recorded complacently, â€Å"and

Historical Terms Essay Example for Free

Historical Terms Essay The Agricultural Revolution was also known as the Neolithic Revolution which occurred around roughly 10,000 B. C. It was a revolution that involved the transformation hunting-gathering societies into establishing permanent settlements and resort to agriculture and domestication. Hence, it initiated the development of civilization. The Cuneiform was probably the earliest form of writing upon which the Sumerians established in the Mesopotamian area, as their civilization started to proliferate, around 3000 B. C. It was said to have lasted for a few thousand years and while its use proliferated, the number of characters that it contained gradually dwindled to a more manageable standard. The Ziggurat was a temple tower which the Sumerians established that existed during Ancient Mesopotamia—almost quite similar to the temples of Ancient America. There were established monuments for the local regions of Ancient Mesopotamia. It was basically a pyramidal structure with a top flat—a platform that served as a shrine or temple. It was elevated to several levels (around two to seven tiers as suggested). The Code of Hammurabi was an ancient law-code (set of society’s rules) which was created in Babylon around 1800-1700 B. C. It was also enacted by Babylon’s sixth king, Hammurabi, upon which the code’s name was derived from. It is just one of the several set of fundamental laws found in the Near East to Middle East—area of Ancient Mesopotamia. Moses is a well-known biblical figure that exists in an array of religions. He was a Hebrew prophet who delivered the Hebrews from Egyptian Slavery and towards the Promised Land which was Israel; although, it was said that he died before he reached Israel. He was well-known for the ten plagues of Egypt that forced the Pharaoh—his stepbrother—into freeing the Hebrews. He was later known for the Ten Commandments. Amenhotep IV was the 10th or 11th Egyptian pharaoh of the 18th Dynasty, reigning around 1300 B. C. It was suggested that he reigned around 1353 to 1336 B. C. He was also known as Akhenaten. In relation to his name, he was noted to have obliged the population into accepting monotheism, the worship of Aten. He was not really the heir to the throne, at least not until his older brother’s (Crown Prince Thutmose) death. Hatshepsut was the fifth pharaoh of the 18th Dynasty, reigning from 1479 to 1458 B. C. She was known as the longest ruling female pharaoh of Egypt; although, it was known in some historic sources that her reign was co-regent and that it was entailed in the reign of Thutmose III. Her most notable achievement was probably the establishment of trade networks in Egypt which apparently brought in wealth for the 18th Dynasty. Zoroastrianism is a religion and philosophy based on the teachings of Zoroaster or Zarathustra, which can be traced in ancient Persia. It is considered as one of the world’s first monotheistic faith, as it exalted Ahura Mazda.. It was believed that many concepts of the three major religions were derived from the scriptures of Zoroastrianism; one of which is the belief on a universal God. Manichaeism was considered as one of the major Gnostic religions of ancient Persia. It said to have existed from the third to the seventh centuries, from as far as China to the Roman Empire. It received prosecutions from other religious cultures such as Buddhism, Christianity, and Zoroastrianism. Its main prophet was Mani who lived in Babylon. Its major concept described the struggle between light and darkness (good and evil). Cyrus the Great was a Persian King who established the Persian Empire under the Achaemenid dynasty, reigning from around 600 to 530 B. C. He started to build his empire by first fighting the Median Empire, then the Lydian Empire, and finally the Neo-Babylonian Empire. He also led his armies into Central Asia and died in a battle against the Scythians before reaching Egypt. It was mentioned that he respected the cultures of the lands he conquered. Hence, this made him a successful emperor to the eyes of his people. Herodotus was a Greek historian who lived around the fifth century B. C. In the Western world, he was known as the father of history. He was the first to apply systematic collection of evidences and data. He usually writes about information regarding the nature of the world and the different sciences, as he would inform people in a narrative way. Sophocles lived from 496 to 406 B. C. and was notably an ancient Greek Tragedian. Luckily, he was one of those Tragedians whose work survived long enough for the modern world to see. His most famous works, which concerned Oedipus and Antigone, have been tackled in schools worldwide. He was also the most-awarded playwright in Athens. Hippocrates lived from 460 to 370 B. C. He was known as one of the most astounding figures of Medicine. He was also known as the Father of Medicine, having established the Hippocratic School of medicine that apparently revolutionized Ancient Greek medicine, which enabled medicine to become a known and necessary profession. The Persian Wars is a series of a Greco-Persian conflicts that arose in 499 B. C. , lasting until around 448 B. C. It was basically the two Persian invasions of Greece which the Greek Alliance successfully repelled. It defined Greek dominance over the Persians. Homer was an Ancient Greek writer that created the epic poems, Illiad and Odyssey. His existence remained controversial as it was yet to be discovered. However, many believed that he existed during the time of the Trojan War, around 1194 to 1184 B. C. , which was the core setting of Illiad. Sophists were basically Ancient Greek teachers of writing, speech, and rhetoric that traveled across the country during the fifth century B. C. A growing demand for education during this century paved the way to the establishment of a class of teachers and professionals that scattered all over Greece in order to educate people. Socrates was a well-known Classical Greek Philosopher that lived from 469 to 399 B. C. He was known to be one of the founders of Western Philosophy, especially his contributions to the field of ethics; through his most comprehensive accounts, the Plato’s dialogues. He was put to trial and executed by forcing him to drink poison and walking around the city. Sparta was a Greek city-state, renowned for its military dominance over its region in Greece. It was established as the rival of the Athenians—during the Peloponnesian war. As a requirement of the governing body, all Spartan men were full-time soldiers, especially during the time of War. Aristotle was an ancient Greek philosopher that lived from 384 to 322 B. C. He was a student of Plato, who later on became the teacher of Alexander the Great of Macedonia. He was also known as one of the Greek philosophers that established the foundations of Western Philosophy (other than Plato and Socrates). Galen of Pergamum was a Roman physician and apparently a Greek philosopher that lived from 129 to 200 A. D. He was known to be the most accomplished physician during the Roman era. His philosophies and theories influenced and dominated much of Western Medical Science. Archimedes was a Greek inventor that lived during 287 to 212 B. C. , known for his theories and foundations on hydrostatics. He was also regarded for his inventions which included an array of siege engines and equipments, and the screw pump, later known as the Archimedes screw. Pax Romana, also known as Pax Augusta, was a long period of relative peace that Rome experienced during the first and second centuries A. D, around 27 B. C. to 180 A. D. It was proclaimed by Caesar Augustus, and it suggested that Rome would go under a period of peace and non-expansion; with generals being recalled after their victories. It met its end at the death of Marcus Aurelius. Diocletian was the emperor of Roman from 284 to 305 A. D. The end of the third century crisis in Rome was signaled by the ascension of Diocletian to the seat of power. He refurbished the empire by separating and enlarging the empire’s civil and military services, assigning three other leaders to control different regions. This was probably the largest and most bureaucratic government in Roman history. Virgil was a classical Roman poet who lived during 70 to 19 B. C. He was known for his three major works: the Bucolics, the Georgics, and the Aeneid—which became Rome’s national epic. Born to a farmer who later lost their land to soldiers, he engaged in farm work and studied poetry. His first two major works were said to have been influenced by rural life. Claudius Ptolemaeus was a Greco-Roman astronomer who lived from 90 to 168 A. D, living in Egypt which was under Roman control. He was an author of several discourses including the Almagest (astronomical discourse), the Geography (knowledge of Greco-Roman world), and Apolotelesmatika (astrological discourse). Titus Lucretius Carus was a Roman Philosopher-poet who lived around 99 to 55 B. C. Although not much was known of him, he was renowned for his major epic Philosophical poem known as De rerum natura, or translated as On the Nature of Things. He dedicated this to his friend, Gaius Memmius. It was said that the poem’s purpose was to free Gaius’ mind of superstition, as well as the fear of death. Octavian was the successor of Gaius Julius Caesar, after the latter was brutally murdered. He ruled from 27 B. C to 14 A. D. wherein he died. He became the first emperor of the Roman Empire, after it was formally established that a sole person would rule the Republic in accordance with the Senate. His rule also initiated the enactment of Pax Romana. Peter was the proclaimed leader of the early Christian church and was one of the apostles of Jesus Christ. He was a simple fisherman that Jesus assigned to take up a leadership role amongst the other disciples and apostles. At the time of Nero, the Christians were prosecuted and with him being the first pope of Christianity, he was nailed to the cross facing downwards and burned in Rome. Paul was a Hellenistic Jew and was referred to as the Apostle to the gentiles. His conversion took place on his way to Damascus when he envisioned a resurrected Jesus Christ, which later on temporarily blinded him. Unlike the rest of Jesus’ apostles, Paul only saw Jesus Christ through his visions and was unfortunate to have not known him in person. Like Peter, he was executed by Nero through beheading. The New Testament is the second major division of the bible wherein the story of Jesus Christ can be read. It contained the gospels upon which shared the life of Jesus Christ and the proliferation of the Christian church. It also contained the book of revelations which was the apocalyptic prophecy. Constantine I, also known as Constantine the Great, was a Roman Emperor who reigned from 306 up to his death on 337 A. D. He experienced his conversion into Christianity on the battlefield. With him as a Christian convert, he reversed the prosecutions laid out by his predecessors and established the Edict of Milan in 313 A. D. , which stated religious toleration throughout the Roman empire. St. Augustine of Hippo was a philosopher and a theologian, as well as the Bishop of Hippo Regius, who lived around 354 to 430 A. D. He was born in Thagaste. He was also regarded as one of the most important Christian figures who helped in the proliferation of Christianity. His thoughts influenced the medieval worldview, the medieval Christian church. The Arians were the followers of a religion called Arianism which was established in 250-336 A. D. by a Christian priest known as Arius. Arians were branded as heretics by the Christian church, thus leading to their execution or excommunication. However, the religion and its followers still continued onwards through the medieval ages. The Justinian Code was summoned by Emperor Justinian himself and his desire to create a single set of laws, or â€Å"code,† which contained the different laws enacted by past emperors from the reign of Hadrian up to his rule. The older laws and codex were updated to fit the standards of Emperor Justinian’s reign. The first part of the law was completed on 529 A. D. Byzantium, known today as Istanbul, was an ancient Greek city established by Greek colonists, naming it after King Byzas. The name was actually Latinized from Byzantion. It became the capital of the Byzantine Empire, after the fall of the Western Roman Empire, and renamed to Constantinople. Later on, the Ottomans laid siege of Constantinople and took over the city. It was then changed to Istanbul when Turkey was established. The Koran is the most important text of Islam; much like the Christian bible. It was believed to be a book of divine guidance for mankind to follow. It was mentioned that the Koran was revealed to the prophet Muhammad by Jibril (an Islam version of Gabriel). The Koran was also believed to have been written by Muhammad and his followers, through the transcription oral transmissions. It was compiled in 633 A. D. and was standardized in 653 A. D. under the Islamic Empire. The Hagia Sophia was a mosque but later turned into a Museum which can be found in the city of Istanbul in Turkey. It was highly considered as the epitome of Byzantine architecture, as it was established as a patriarchal basilica at that time. For nearly a thousand years, it was considered as the largest cathedral in the world. When the Ottomans conquered Constantinople, it was converted into a mosque. Theodora was the empress of the Byzantine Empire during the sixth century A. D. and the wife of Emperor Justinian I as the emperor of the Byzantine Empire. She was regarded as a saint of the Orthodox Church. She was also known as the most influential woman in the history of Byzantine. Feudalism was an established political system during the medieval ages in Europe, as well as the rest of the world. Three key elements revolve around Feudalism: lords, vassals, and fiefs. The Lords control the land and provide protection for it. The vassals establish a contract with the controlling monarch, ensuring the protection of the land and his property. The fiefs are profitable lands that could gain revenue for the kingdom. Charlemagne was the established King of the Franks who reigned from 768 A. D. up to his death in 814 A. D. He united the Frankish kingdoms and expanded into Western and Central Europe, establishing an empire. Later on, he conquered Italy and was crowned by Pope Leo III as Imperator Augustus, and became a rival of the Byzantine Emperor sitting on Constantinople. During his reign, the empire experienced Carolingian Renaissance which was the revival of art, culture, and religion through the medium of the Church. Alcuin of York lived from 735 to 804 A. D. in York, Northumbria. At the request of Charlemagne, he became a teacher in the Carolingian court, which focused on the revitalization of art, culture, and religion through the medium of the Church. He composed many theological doctrines, as well as a notable number of literary works like poems. He was inducted as the abbot of Saint Martin’s at Tours in 796 A. D. , until his death. Clovis I was the first king of the Franks brought Christianity to the Franks and aimed to unite the Frankish kingdoms under one ruler. Instead of remaining as an Arian Christian which was very common to the Germanic tribes, he converted to Catholic Christianity and brought this to his people. He was baptized near Rheims wherein the succeeding kings would be crowned as King of France. Serfs were people belonging to the lowest class in the feudal system of medieval Europe which was Serfdom. Basically, they were slaves to serf lords and were tasked to till the lands. They had no freedom and only had barely enough to feed themselves. They do not own the lands they till. Rollo was the first ruler of the Viking principality in Northern France, later known as Normandy. He lived from 860 to 932 A. D. He invaded France in 885 A. D. , and was considered as one of Sigfred’s Viking Fleet’s minor leaders. He was defeated by King Charles the small of France and later gave him the northern area of France with the condition that he would defend the French Kingdom from other Viking raiders. The Magna Carta is an English charter that was issued in 1215 A. D. It gave noblemen certain rights. It also required people to respect legal procedures, and accept that the person’s freedom could be dully bound by law. It also protected the King’s subjects from unlawful imprisonment. Basically, it was made by noblemen to somewhat limit the powers of the King, in order to avoid Tyranny over the kingdom. William the Conqueror or William I was the King of England from 1066 up to his death in 1087 A. D. He was known as William the Bastard because of his illegitimate birth. Along with his men, he fought against the English at the Battle of Hastings and won. As King, he made a lot of major reforms in the English administrative system.

Diagnosis and Management of Bronchopleural Fistula

Diagnosis and Management of Bronchopleural Fistula Introduction A bronchopleural fistula (BPF) is a communication between the bronchial tree and the pleural space. More than two thirds of BPFs are postresectional, with an incidence ranging from 1.5-28 % after pneumonectomy, and 0.5% after lobectomy. Postresectional BPF is associated with mortality of 20-50 %.[1] BPFs can present early (1-7 days), intermediate (8-30 days), or late (more than 30 days) after pulmonary resection. Early fistulas are usually associated with dehiscence of the bronchial stump, while late fistulas are usually associated with failed healing or infection.[2] Besides postresectional etiology, BPFs may be idiopathic, or secondary to necrotizing lung infections, persistent spontaneous pneumothorax, thoracic trauma, Adult respiratory distress syndrome, Tuberculosis, or postprocedural e.g. lung biopsy or bronchoscopy.[3] Diagnosis and management of BPF is a major challenge for clinicians. Diagnosis and localization of BPF may require multiple chest computed tomography (CT) imaging and bronchoscopies.[4] A BPF is usually a manifestation of the underlying lung disease, therefore, measures to reduce the air leak are generally unsuccessful until the patients underlying lung disease has improved. Once there is diminished need for mechanical ventilation, the BPF almost always resolves without specific therapy, apart from controlling active infection and draining the pleural space adequately. Definitive repair using surgery or various bronchoscopic methods has been used to close BPF if either conservative management fails, or is not expected to succeed.[5] Case Description A 69 year old male with squamous cell carcinoma of the right lower lobe (RLL) of the lung underwent thoracotomy and RLL resection. The patient was discharged home on the 6th postoperative day after an uneventful hospital course. The patient presented to the emergency department of an outside hospital ten days later with fever and respiratory distress. Chest X-ray showed a large pneumothorax, and a right sided chest tube was placed. Pleural fluid was sent for culture and sensitivity, and later grew staphylococcus aureus. The patient’s breathing continued to be labored, and was intubated urgently after failing a short trial of non-invasive positive pressure ventilation (PPV). A large air leak was observed through the chest tube with each positive pressure breath, even after placing the chest tube on continuous suction. Placement of an endobronchial valve to minimize air leak was attempted in the interventional bronchoscopy suite, but failed and was reported to be technically dif ficult. The patient was subsequently transferred to our hospital for further management. On admission, ventilatory management in the intensive care unit (ICU) was geared towards lowering the tidal volume and plateau airway pressure to minimize the air leak. This was accomplished by providing partial ventilatory support using low rate synchronized intermittent mandatory ventilation (SIMV) and a high inspiratory flow rate, as well as decreasing PEEP, inspiratory to expiratory (I/E) ratio, and the tidal volume of each ventilator delivered breath. We used the least amount of chest tube suction that maintains lung inflation, treated bronchospasm aggressively, and continued appropriate antibiotics. We suspected that the patient had a RLL airway stump dehiscence resulting in a BPF, and complicated with staphylococcus aureus empyema. Chest CT (Figure 1) showed a properly placed right sided chest tube surrounded by residual hydropneumothorax. Bronchoscopy showed a defect in the suture line of the RLL airway stump. The patient was taken to the operating room (OR) to close the BPF through a right thoracotomy after switching the single lumen endotracheal tube to a left sided double lumen tube. The abscess cavity was cleaned revealing a 0.6 cm airway stump opening at its base. The stump opening was sutured and mattressed with intercostal muscle pedicle. A Clagett window was created, the cavity was packed tightly, and a vacuum assisted closure dressing was applied. The patient was extubated in the OR to minimize PPV. Antibiotics and dressing changes were done until the patient was discharged from the hospital on the 6th postoperative day. The wound was ultimately closed five months later when the Clagett window decreased in size and healed appropriately. Diagnosis Signs and symptoms of BPF include fever, productive cough, hemoptysis, subcutaneous emphysema, and persistent air leak or purulent drainage from a chest tube. Late fistulas with empyema may be associated with nonspecific symptoms e.g. fever, cough, and shortness of breath. Chest radiographs usually demonstrate a new air-fluid level (hydropneumothorax) in the pleural space.[6] Both chest CT and bronchoscopy are useful in establishing diagnosis, identifying the cause and localizing the bronchopleural fistulous track.[4] Chest CT can also define the empyema cavity and assess the severity of coexisting lung disease. Bronchoscopy can also be used to inspect the bronchial stump, obtain cultures, and assess the contralateral airway. In addition to direct visualization of central BPFs, bronchoscopy can localize peripheral ones by passing a balloon into suspected bronchial segments separately and then inflating for 30-120 seconds. A reduction in air leak through chest tubes would identify the bronchial segment communicating with the BPF.[7] Management Management of BPF is difficult and depends on the underlying cardiopulmonary reserve, nutritional status, fitness to undergo a major surgical procedure, surgical expertise available, and the size and location of the fistula. Conservative management: The primary goals of BPF management include treating the underlying lung disease, reducing the air leak through ventilator adjustments to minimize the tidal volume and plateau airway pressure, and avoiding contamination of the contralateral lung by either positioning the patient with the affected side down or controlling the airway with a double lumen endotracheal tube if needed. Small fistulas can be managed conservatively if the patients clinical condition is stable and the pleural space is well drained. This is achieved by insertion of a chest tube in the pleural cavity, with either minimal or no suction to allow the lung to expand without encouraging air leak through the fistula. Conservative management is safe as long as empyema is drained promptly, but might not be suitable for patients requiring prolonged mechanical ventilation.[8] The chest tube can be connected to a one-way valve and the patient can be treated as an outpatient.[9] Ventilatory management: [9,10] Ventilatory management of BPF is geared towards keeping airway pressures below the critical opening pressure of the fistula by reducing the respiratory rate, tidal volume, inspiratory time, PEEP, plateau airway pressure, and transpulmonary pressure gradient. This can be achieved by implementing the following measures: Provide partial ventilatory support e.g. low rate SIMV or Pressure Support. Decrease the tidal volume of each ventilator-delivered breath (5 to 8 mL/kg) Use a high inspiratory flow rate e.g. 70 to 100 L/min. Decrease I/E ratio. Minimize inspiratory time to decrease mean airway pressure, avoid end-inspiratory pause and inverse-ratio ventilation. Minimize PEEP (both dialed-in and auto-PEEP). If previous adjustments are not possible or insufficient, a strategy of permissive hypercapnia is appropriate (decrease minute ventilation and allow arterial PCO2 to rise). Use the least amount of chest tube suction that maintains lung inflation. Avoid patient positions that increase the leak, and keep patient heavily sedated (and paralyzed if needed) if spontaneous movement exacerbates air leak. Treat bronchospasm and other causes of expiratory airflow obstruction. Wean and extubate patients as soon as possible. If the measures mentioned above failed, consider unconventional ventilatory measures e.g. independent lung ventilation,[11] high-frequency jet ventilation,[12] or airway pressure release ventilation.[13] If ventilation continues to be problematic, veno-venous extracorporeal membrane oxygenation (ECMO) can be used temporarily until further bronchoscopic or surgical control of BPF is done.[14] Bronchoscopic Management: Interventional bronchoscopy is usually reserved for BPF in patients with high surgical risk and poor general condition, or small fistulas in stable patients after drainage of the pleural space has been achieved and infection is controlled.[15] These procedures are limited to isolated case reports or short case series; the current literature does not allow adequate comparison of different bronchoscopic techniques. Peripheral fistulas (post-lobectomy) tend to be more amenable to this family of techniques compared with more centrally located fistulas (post-pneumonectomy). Bronchoscopic management of BPF is based on the delivery of different materials and small devices into the BPF sites.[16] Examples include: A plug composed of Gel Foam, fibrin, autologous clot, or tissue glue. An endobronchial one-way valve. (Figure 2 3) An expandable endobronchial stent. Local application of silver nitrate. Coagulation of the injured site with the Nd:YAG laser. Antibiotics e.g. Doxycycline, or tetracycline injections. Silicone fillers, coils, and amplatzer devices. Surgical Management: Surgical management has a success rate of 80-95 %, but it is associated with high morbidity and mortality. Surgery can be performed as a one or two stage procedure. A one stage procedure is indicated when the BPF occurs within the first few days after surgery. Management usually includes closure of the BPF by reclosure of the bronchial stump reinforced with omental or pedicled flaps, and obliteration of the residual pleural space.[2,17] Management of late occurring fistulas or if an empyema is present involves a two-stage approach. Drainage of the pleural space and debridement of empyema cavity is followed by repair of the air leak once the pleural space is sterile (e.g. Modified Clagett Technique).[18,19] Chronic empyema may need thoracoplasty with removal of a part of the chest wall.[5] If the BPF cannot be identified, open window thoracotomy and daily dressing may be helpful. Success of surgical management is improved by ensuring appropriate antibiotic therapy, adequate nutritional support, and proper care of chest tubes, as inadvertent occlusion can be complicated by tension pneumothorax.[8] Conclusion BPFs offer many management challenges in a complex patient population. The aforementioned case report demonstrates the spectrum of morbidity associated with this serious problem. A post-resection occurrence is the most common etiology, and the diagnosis is usually confirmed with chest CT and bronchoscopy. BPFs require a multimodal management strategy and should be handled in centers with experience with this complex problem. Management includes control of infection, pleural drainage, proper pain control, nutritional support, and ventilatory management tailored to minimize air leak. Both surgical and non-surgical options can be utilized for management of BPFs. Bronchoscopic procedures such as endobronchial valves are emerging as viable treatment options but should be used on a case-by-case basis. Figure 1: Chest CT: Panel A shows a residual hydropneumothorax around a right sided chest tube. Panel B represents a coronal reconstruction that shows the BPF (The arrow points to the communication between the right lower lobe airway and the right pleural space). Image courtesy of Dr. Ahmed El-Sherief. Figure 2: A bronchoscopic image from another patient with right upper lobe BPF. The image shows 2 endobronchial valves seated in the anterior and posterior segments of the right upper lobe. Image courtesy of Dr. Thomas Gildea. Figure 3: The Spiration Valve System (SVS) is self expanding and conforms to the airway. During inspiration (A), the valve blocks distal airflow. During expiration (B), the valve allows trapped air and secretions to escape. Reduction in airflow may accelerate resolution of an air leak. Copyright  © 2013 Spiration, Inc. Reprinted with permission.

In Frederick Douglasss Narrative of the Life of Frederick Douglass, Es

In Frederick Douglass's Narrative of the Life of Frederick Douglass, he appeals to the interest of the reader through his first hand accounts of slavery, his use of irony in these descriptions, and his balance between indirectness and honesty. Douglass's descriptions of the harshness of slave life are filled with horrific details able to reach even the coldest hearts. The beginning of the book describes how Douglass lacks even the simplest knowledge of his own age. He goes on in the book to describe how he has no accurate knowledge of his age, because he has never seen any of the authentic records containing it. By far the larger part of the slaves, know as little of their ages as horses know of theirs, and it is probably the wish of most masters to keep their slaves with only a limited amount of knowledge. In saying this Douglass is showing how low the life of a slave is compared to other humans. The idea of slaves being seen as merely work animals is placed into our minds and is set for an idea to shape the life of Frederick Douglass. Douglass also gives acco...

journeyhod A Journey into the Heart of Darkness :: Heart Darkness essays

A Journey into the Heart of Darkness   The white man is evil, or so says Joseph Conrad in his novel Heart of Darkness, which describes the colonial transformation of the symbolically angelic African wilderness into an evil haven for the white man.   The novel presents a psychological journey into the core of evil or "heart of darkness" in one's own mind, as he or she progresses through the jungle. The reader follows Marlow, the novel's narrator, along such a journey.   His psychological changes as he approaches the heart of darkness are evident, as the reader observes, in his views of the African natives, lying and Kurtz.     Marlow is an honest man.   He sets out on a genuine search for answers to his questions of exploration of the unknown "when (he) was a little chap" (Conrad 64).   Marlow was drawn to a certain place on the world map, called the Congo "the biggest, the most blank, so to speak---that (he) had a hankering after" (Conrad 64). Upon first entering the mouth of the Congo River, Marlow declares his stance on lies and those who lie.   [He believes that lying in the worst thing for a person.] He vows never to lie in his life.   After reading Kurtz's report about his progress down the Congo, Marlow finds that Kurtz lied, and in part loses all the respect he ever had for Kurtz.   However, Marlow still continues to pursue him.   Marlow continues his journey up the Congo River, penetrating further and further into the heart of darkness.   In the process, Marlow reverts back to his innate state to survive, whether or not that means going against his principles.   Finally, 200 mi les later, Marlow meets Kurtz, who is the object of his psychological desire, only to find him very ill.   After Kurtz's death, Marlow finds himself transformed into a person he thought he would never become, a liar.   Marlow lies to Kurtz's intended about Kurtz's last words when he returns to Europe. After being consumed by the heart of darkness, Marlow throws away his previous values as he reverts into a savaged, almost evil state of mind.     Though honest, Marlow is a prejudiced man; he is the epitome of colonialism.   Going into the Congo, Marlow views the natives as prehistoric evils in desperate need of white influence and civilization. Throughout the physical journey, Marlow is confronted with the natives time and time again, seeing them chained as slaves, living in a village and attacking his own steam boat.

Example Essay for Primary Research

OUTLINE I. Introduction * Definition of young adults: Take responsibilities for their own action (Newman, B. M & Newman, P. R, 1983) * Young adults should live with their parents. II. Body 1. Save money * Affected by economic crises: Number of youth unemployment (Barnes, 2012) * Save the daily expenses ( Vander Zanden, 1997) 2. Close relationship among family members * Parents: + Support emotion (Philip, 1998) + Take care of each other (Logan & Spitze, 1996) * Siblings: + Share every day routines (Newman, B. M & Newman, P. R, 1983) + Confide each other (Newman, B. M & Newman, P. R, 1983) . Reduce bad effects for personal development * Evidences: + Unexpected pregnancy (Philip, 1998) + Less successful marriages and work lives (Berk, 1998) + Increased depression (Rosenfeld, 2010) * Role of family: Safety net (Berk, 1998). 4. Counterargument and refutation: * Counterargument: Young adults will gain experience when they leave home * Refutation: + Parent’s opinions are better than peer’s opinion (Newman, B. M & Newman, P. R, 1983) + Important role of social support from parents (Philip, 1998) + Free to go out to get experience because of democracy parents (Turner & Helms, 1989) III.Conclusion Young adults should remain to co-reside with their parents because of the lack of advices, financial and emotional support from their family (Berk, 1998). Young generations play an importance role for the future generation in their country. The government always gives priority to these generations including children, adolescents, and young adults. However, young adults acknowledged to have rights to take responsibilities for their own action (Newman, B. M & Newman, P. R, 1983) possess the best for developing the country.Whether early adults should live at home with their parents or leave their parental home is still controversial. In our opinion, early adults should co-reside with their parents for several reasons. The first reason why early adults should live wit h their family is that they have an opportunity to save money. Economic circumstances present many challenges for young adults because most usually graduate from high school, they find a place in college and start a job (Crandell, T. L, Crandell, C. H & Vander Zanden, 2009).Besides, economic crises have led unemployment for â€Å"75 million† young people between the ages of 15 to 24 years old (Barnes, 2012). Due to the low starting salaries, many young adults struggle to pay their daily expenses (Vander Zanden, 1997). Furthermore, according to Hartley (1993), in Australia, 45% of surveyed people said the main reason for returning home in the first time is financial problems. Secondly, early adults who do not make a residential transition have a closer relationship with family members than those leaving home do.Beside financial support, children will receive love and moral support from their parents (Philip, 1998). Parents, moreover, are willing to provide guidance for their c hildren that help them make better choices and decisions. As a result, the relationship between parents and children is more valuable than young adults and peers (Logan & Spitze, 1996). In addition, the siblings are typically the first peer group in both childhood and adulthood. Young adults living at home benefit from sharing every day routines ith their siblings like joining he meal, splitting dress or taking care of one another, especially, when they are ill (Newman, B. M & Newman, P. R, 1983, p. 231). Furthermore, when young adults cope with problems to express themselves with their parents, teachers and social peers, the siblings are likely to be appropriated people to confide (Newman, B. M & Newman, P. R, 1983). Thirdly, early adults living at home will reduce bad effects on personal development. Young people are likely to become self-indulgent including the temptation of drugs and alcohol when there is no parental supervision.According to Philip (1998), negative economic and social effects leading to a great number of dangers as â€Å"teen-aged motherhood† are the results of leaving home at very early young age (p. 557). In addition, detaching themselves from their net at young age make early adults hard to succeed in marriage and work (White as cited in Berk, 1998). Nevertheless, young adults presume that the goal of leaving home is to have an independent life, which makes them easily anxious and depressed (Olds & Schwartz as cited in Rosenfeld, 2010). Bruch et al. Cheek & Busch (as cited in Berk, 1998) said that â€Å"socially anxious people report more loneliness† (p. 461). Therefore, the family is the best address to release stress and decrease social dangers for early adults because â€Å"the parental home serves as a safety net and base of operation for launching adult life† (Berk, 1998, p. 463). The opponents of co-residence with parents say that young adults will get experience when leaving home. However, gaining experience does not depend on who they live with and young adults can get valuable experiences while living with their parents.In fact, peer’s advices are not always as reliable and effective as parents’ in some cases (Newman, B. M & Newman, P. R, 1983). Moreover, the necessity of social support from their parents for the maturity of young adults was the conclusion of a study of 175 18 and 19-year-old college students (Philip, 1998). According to Turner and Helms (1989), 83% of the adolescents have â€Å"democratic parents† (p. 288) because they still have the freedom to participate in social activities and do part-time jobs to broaden knowledge when living at home.Additionally, they also can help their parents with household chores, which narrows the generation gap and helps them learn essential skills for an independent life later. In conclusion, due to the current economic crises and dramatic changes in society, especially the increase of social dangers, young adults sh ould live in their parental home to avoid harmful influences on themselves and their family as well. By contrast, young adults who decide to leave home at an early age may face difficulties for a long time because of the lack of advices, financial and emotional support from their parents (Berk, 1998). Words: 769REFERENCES Barnes, H. (2012). Global Youth unemployment: Making sense of the numbers. BBC News. Retrieved from http://www. bbc. co. uk/news/business-19745115. Berk, L. E. (1998). Development through the lifespan. The USA: A Viacom Company. Crandell, T. L. , Crandell, C. H. , Vander Zanden, J. W. (2009). Human Development. (9th ed. ). New York: The McGraw-Hill Company. F. Philip Rice. (1998). Human Development. (3rd ed. ). The USA: A Viacom company. Hartley, R. (1993). Young Adults living at home. Australian Institute of Family Studies. Reproduced from FAMILY MATTERS no. 36 December 1993, pp. 35-37. Retrieved from http://www. ifs. gov. au/institute/pubs/fm1/fm36rh1. html. Loga n, J. R. , Spitze, G. D. (1996). Family Ties: Enduring Relations between Parents and Their Grown Children. The USA: Temple University. Newman, B. M. , Newman, P. R. (1983). Understanding Adulthood. The USA: CBS College Publishing. Rosenfeld, M. J. (2010). The Independence of Young Adults, in Historical Perspective. Journal of Family Therapy Magazine, 9 (3), 17-19. Turner, J. F. , Helms, D. B. (1989). Contemporary Adulthood. (4th, ed. )The USA: Saunders College Publishing Vander Zanden, J. W. (1997). Human Development. (6th ed. ). The USA: The McGraw-Hill Company. .