Read the garduition story and after that answer the 3 question of end Essay

Read the garduition story and after that answer the 3 question of end of the story - Essay Example Angelou surprises her reader by relating her thoughts during the course of the graduation ceremony. She explains how the white politician takes the stage and insults the students by implying that the only jobs for which blacks are suited is manual labor and sports. The most jarring moment for the reader occurs at the end of the essay when Angelou describes the class singing the Negro National Anthem as a form of protest. 2. The ancient tragedy Angelou is describing is the tragedy of the slave being sold on the dais during the time of slavery in America. Angelou depicts the disgrace of this event. Professor Parsons is on the stage, but just like the slave being sold at auction, â€Å"his eyes said he was no longer with us.† He is detaching himself from the situation just as his ancestors did. Angelou changes the tragedy by relieving the disgrace at the end of the ceremony. Instead of ending in tragedy as the sale of a slave does, the graduation ceremony ends with a note of hope. As Angelou states, â€Å"we were on top again.† 3. Like Angelou, I was involved in an event in school that I greatly anticipated. I was very active in the drama club in high school. We would always put on three plays a year, and each one was a production that took a tremendous amount of effort to create. The technical crew would spend hours after school making sure that the sound and lighting was perfectly timed. The art classes at school would help paint the sets, and various students would build different sets using the tools from the woodworking class. The mothers of all the drama club students would stitch the costumes. I was always a part of the cast, in minor roles and major roles. One year, we chose a particularly difficult production, Alice in Wonderland. The costumes were very elaborate and took months to create. Because of the psychedelic nature of the play, the sets required bright colors and

Manifest Destiny Essay Example for Free

Manifest Destiny Essay The belief in Manifest Destiny, America’s right to expand westward, was popular among the Democratic Party, which paved the path for conflict in U.S. politics. In the 1840’s, Manifest Destiny was used as justification for the annexation of Texas, the war with Mexico, and to acquire portions of Oregon from the British. The debate over whether America really had a manifest destiny to expand all the way west or if it was used as an excuse to acquire more land led to debates in U. S. politics. Advocates of manifest destiny, mostly democratic, argued that the U.S., as a more advanced culture, had a God-given right to expand its borders. They believed the expansion would civilize the West and America’s democratic, cultural, and religious values would benefit the Native Americans. In addition, supporters would argue that the belief would strengthen the union, making it invulnerable. On the opposing side, consisting mostly of the Whig party, the God-given right to expand all the way westward at the price and rights of thousands of innocent natives was blasphemy. The Whig party was not manifest destinies only critic, abolitionist, fearful of slavery spreading, argued that the constitution did not give the country the right to gain new land and the country’s vital institutions would suffer as America was spread too thin. Look more:  essays on manifest destiny Texas’ sought to join America as a new state, after it gained independence from Mexico and had a revolution. The process of expansion in which newly democratic and free states would seek entry into the United States, rather than the U.S. extending its government over unwanting people was ideal. The Democratic Party was threatened to fall apart if Texas entered the Union, as it would become another slave state and this forced both Presidents Jackson and Van Buren to decline Texas’ plea. During the election of 1844, both Henry Clay of the Whig Party and Van Buren of the Democratic Party were against the annexation of Texas, this displeased the Democrats as they wanted to gain Texas so they dropped Van Buren in favor of James Polk, who was for adding Texas as another slave state. Polk cleverly tied Texas’ annexation into the Oregon dispute, the controversy over Oregon’s border. In 1846 the dispute was settled over the Oregon Treaty where the British relinquished its holding to the lower Colombia basin. This appeased expansionist in the north, who fought for Oregon and expansionist in the south, who focused primarily on Texas. After Polk’s election, he moved to occupy a free portion of Texas that was still claimed by Mexico. This sparked the Mexican-American War in 1846, were there were calls for â€Å"All Mexico†, mostly from Eastern Democrats, however Mexico’s annexation brought up much debate. If Mexico were to become a part of the United States it would mean millions of non-white Mexicans would become U.S. citizens, something Americans were not too keen on. The racist aspect of Manifest Destiny considers inferior Mexicans unqualified to become Americans whereas the mission aspect of Manifest Destiny dictates that Mexicans would become improved under American democracy. The â€Å"All Mexico† movement quickly abated with the Treaty of Guadalupe Hidalgo in 1848 which granted Alta California and Nuevo Mà ©xico to the United States, both of which were sparsely populated with Mexicans. After the Mexican-American War ended in 1848, disagreements over the expansion of slavery made further annexation by conquest too divisive to be official government policy. The belief in Manifest Destiny in the 1840’s greatly influenced both U.S. politics and policy and is to blame or thank for Americas expansion from â€Å"sea to shining sea.†

Pulmonary Embolism as Manifestation of Right Atrial Myxoma

Pulmonary Embolism as Manifestation of Right Atrial Myxoma A  case report and review of literature Abstract We present a case of a 55-year-old man who suffered from shortness of breath and syncope; he was sent to our department for suspecting pulmonary embolism. We proceeded Computed tomography pulmonary angiography (CTPA) and Transthoracic echocardiogram (TTE) , confirmed the diagnosis which was caused by right atrial mass. After the surgery the patient was diagnosed as right atrial myoma (RAM) with pulmonary myoma emboli without no adverse event. The residual emboli were partially improved after one month anticoagulation. We reported this case and review of the relevent literature to help clinicians improve the understanding of diagnosis and treatment of pulmonary embolism caused by RAM. Key words: pulmonary embolism, right atrial myxoma, treatment Pulmonary embolism, most commonly originating from deep venous thrombosis (DVT) of the legs, ranges from asymptomatic, incidentally discovered emboli to massive thromboembolism causing immediate death. PTE is a life-threatening disease with a high morbidity. Annually, as many as 300,000 people in the United States die from acute PTE, which is much more common in China at present than 10 years ago (1). About 50-70% emboli of pulmonary embolism originated from deep venous thrombosis (DVT), most of which in lower extremities. Such patients without DVT should screen occult cancer. Although cancer associated venous thrombosis was widespread described, the emboli from benign tumor are less mentioned (2). Majority of the atrial myxoma complicated pulmonary emboli are tumoral, thrombotic emboli were less reported (3,4). We report a rare case of RAM with a pulmonary localization mimicking pulmonary emboli. Case presentation A 55-year-old man was admitted to emergency room with gradually increased shortness of breath for 2 months, syncope and right chest pain for 6 hours. He had a habit of long time sitting and a history of 20 pack-year smoking, and stopped smoking 10 years prior to admission. Initial assessment revealed cyanosis and right breath sound decreased. No pitting edema in lower extremities. Laboratory tests showed ALT 52IU/liter; 93IU/liter; D-Dimer >10ÃŽ ¼g/ml; NT-proBNP 3544 Ñâ‚ ¬g/ml; Troponin I 0.49 ng/ml. Arterial blood gases revealed severe hypoxemia, oxygenation index was 89mmHg; Electrocardiogram showed Sà ¢Ã¢â‚¬ ¦Ã‚  Qà ¢Ã¢â‚¬ ¦Ã‚ ¢Tà ¢Ã¢â‚¬ ¦Ã‚ ¢. CTPA revealed right main (Figure 1a), both lobar(Figure 1b,1c) and segmental (Figure 1d) pulmonary arteries(PA) multiple filling defects; right atrium irregular mass(Figure 1d). TTE showed enlargement of right chambers and a right atrial 54*47mm mass attached to the top wall, clear margin, irregular and partial rough on surface, l oose in internal structure, moving along with cardiac cycle, mild prolapse through the leaflets of the tricuspid valve and orifice of inferior vena cava, moderate regurgitation of tricuspid valves with mild pulmonary hypertension. Compressed venous ultrasonography showed negative in both lower limbs. The surgical approach was through a medial sternotomy under extracorporeal circulation. The right atrium wall was opened and a gelatinous consistency tumor with necrosis, fragile, measuring 40*50mm, adhering to the inter-atrial septum (Figure 2), a 30*20*70mm tumor embolus in the right main PA, the distal end was near right upper PA. The tumor cells expressed CD34 and calretinin, and were negative for CK and SMA. The histopathological examination confirmed myxoma (Figure 3) in right atrium and right pulmonary artery. The patient was treated warfarin (target INR, 2-3) for 1 month. Repeated CTPA showed left lower PA filling defect with no improvement after 2 months (Figure 4c), right and other left PA filling defect resolved (Figure 4a, 4b). 2 years follow-up he was asymptomatic. Discussion Cardiac tumors are less common, most of which are from metastasis. The incidence rate of primary cardiac tumors (PCTs) in autopsy ranges from 0.02 to 2.8†°. 30-50% of PCTs are myomas, 75% in the left atrium and only 10-20% arising in the right atrium, which may developing from embryonic or primitive gut rests (5,6,7). Histologically, they consist of an acid-mucopolysaccharide rich stroma. Polygonal cells arranged in single or small clusters are scattered among the matrix. The clinical manifestations of RAM may remain asymptomatic or appear with constitutional, obstructive or embolic symptoms according to the size, fragility, mobility, location of the tumor as well as body position and activity (5,8). Nonspecific constitutional signs, which present in 10-45% of patients with myxoma, are fatigue, fever, dyspnea, chronic anemia, weight loss, general arthralgia, and increase of IL-6, ESR, and CRP (8). Therefore the results of laboratory tests may mimic those for rheumatic disorders. These signs are more common for patients with large, multiple, or recurrent tumors, and usually recovered after resection (9). Pulmonary embolism of RAM fragments or thrombi from the surface may also occur, resulting in dyspnea, pleuritic chest pain, hemoptysis, syncope, pulmonary hypertension and right heart failure even sudden death. Acute abdominal pain was mentioned in two cases (10). Embolic event in cardiac myxoma is common, with the incidence ranging from 30% to 40% (5) . In the cases of RAM with pulmonary embolism, a smaller size, villous or irregular surface and multi-foci are most common factors associated with embolization (11). The duration period was ranging from 1 day to 3.5 years. The age of patients ranged from 17 to 76 years (mean age 42.8 years), with a higher incidence in women (20/35, 57%). In these cases RAMs are usually attached by a short pedicle to the inter-atrial septum (22/35), mostly in fossa ovalis, others are in free wall, crista terminalis, Koch triangle and multiple origins. Most of the patients were diagnosed with TTE (Transthoracic echocardiography), CT, transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI), others were with angiography and autopsy. In almost all cases treatment was surgical with removal of the intra-atrial myxomas and the pulmonary emboli, which are usually tumoral. Majority of such patients recovered well after surgery. Four preoperative deaths, two postoperative deaths were reported. Right atrial thrombosis, transient ischemic attack (TIA), ischemic hepatitis and renal failure were the rare complication (Table 1). TTE and TEE are the most commonly used diagnostic methods in the detection and initial description of atrial myxomas (23). TTE is nearly 95% sensitive for the confirmation of cardiac myxomas, and TEE reaches nearly 100% sensitivity (45). TTE facilitated bedside test to safely detect myxomas in fatal pulmonary embolism as in our patient. TEE produces explicit images of small tumors (1 to 3 mm in diameter), especially in fat patients with poor TTE images (46). The TEE also permits a clearer picture of the attachment of the tumor and more precise characterization of the size, shape, surface, inner structure and location of the mass (47). Although TEE is a semi-invasive diagnostic test with a very low rate of significant complications, lethal pulmonary embolism during TEE procedure has been reported (22). Superior to echocardiography, multi-detectors spiral computed tomography (MSCT) and cardiac magnetic resonance imaging (CMR) are more accurate in determining the relationship to normal intra-cardiac structures and tumor infiltration into the pericardium, extension to adjacent vasculature and mediastinal structures, pulmonary arteries emboli and surgical planning (48,49). RAMs manifest as a low-attenuation intra-atrium mass with a smooth, irregular or villous surface on MSCT. Calcifications are seen in about 14% and are more common in right side lesions. Arterial-phase contrast enhancement is usually not apparent, but heterogeneous enhancement is reported on studies performed with a longer time delay (50,51). Varying amounts of myxoid, calcified, hemorrhagic, and necrotic tissue gives them heterogeneous appearances on T1 and T2-weighted images. Delayed enhancement is typical and usually patchy in nature. Steady state free preceesion (SSFP) sequences may slow prolapse through the tricu spid valve in diastole phase and can suggest the attachment point of a stalk lesion. Reconstruction of cine gradient recalled echo (GRE) images enables assessment of lesion mobility and attachment (52). 18F-FDG PET/CT can help the noninvasive preoperative confirmation of malignancy (41). Mean SUVmax was 2.8 ±0.6 in benign cardiac tumors and significantly higher in both malignant primary and secondary cases. (8.0 ±2.1 and 10.8 ±4.9). The SUVmax of myxoma is ranging from 1.6 to 4. Malignancy was determined with a sensitivity of 100% and specificity of 86% with a cut-off SUVmax value of 3.5. A weak correlation between the SUVmax and the size of tumors is found due to the partial volume effect, cardiac motion and respirtatory movement (53). Angiography is an invasive investigation that presents an additional risk of inducing migration of the tumor and only suitable for suspected acute coronary heart disease (37). Surgical removal of the RAM with pulmonary embolism is the first treatment of choice and usually curative (44,45). The crucial aspects of surgery are measures for bi-caval cannulation to prevent intra-operative embolism (27), en-bloc excision of the myxoma with a wide cuff of normal tissue, removal of fragments in pulmonary arteries, and conducted under moderate or deep hypothermia, low circulatory flow or total circulatory arrest based on the extent and sites of the emboli (44). Surgical treatment leads to complete resolution with low rates of recurrence and good long-term survival. The overall recurrence rate is about 1–3% for sporadic atrial myxoma (5,54), which grows an average of 0.24–1.6 cm per year. The risk of recurrence pulmonary embolism after resection has been reported to be 0.4% to 5.0% and interval from excision to recurrence is reported ranging from a few months to 8 years (55). The reasons of RAM recurrence include multifocal origin, incomplete surgical resection, familial disposition or abnormal DNA ploidy pattern. Postoperative annual TTE, V/Q scan for long-term observation should be followed up to detect eventual recurrence of new myxoma and pulmonary embolism. Excision of the recurrent lesions may be the only choice of treatment because of the poor role of chemotherapy and radiation (28). Pulmonary emboli from RAM are usually tumoral, although discriminating myxomas from thrombi in pulmonary arteries is difficult. Daniel T et al (56) presented the first case of paradoxical pulmonary embolism in the presence of a left atrial myxoma withouingt intra-cardiac shunting, potentially secondary to a combination of hemolysis, hemeoxygenase-1 up-regulation, systemic hypercoagulability/hypofibrinolysis, and regional venous stasis. Pulmonary thromboembolism complicated to RAM improved by coumadin therapy in a refused surgery patient (40). In our case the surgery do not remove the right side emboli, while anticoagulation was helpful for residue emboli remission, which confirmed coexistence of myxoma and thrombi. We suggest anticoagulation may be the useful in unresectable myxoma with pulmonary embolism. The duration of anticoagulation in pulmonary thromboembolism is at least three months, but the course in patients with RAM is still unknown. Conclusion According to review of the literature, RAM may not be timely diagnosed, or even totally undiagnosed. Because of the fragile consistency of RAM, pulmonary embolism are the most common comorbidity and mortality disease, usually be fatal. Surgical removal of masses from the atrium and pulmonary arteries is almost uneventful. Although the association between right atrial myxoma and pulmonary embolism has been described, the presence of thrombi was less mentioned. We suggest anticoagulation may be a choice of treatment after operation, especially in incomplete resection cases. Annual TTE and V/Q are suggested for a period of 8 years when the risk of recurrence is reported. Competing interests The authors declare that they have no competing interests.

Sears Case Study Essay -- essays research papers

Sears Case Study Introduction The great advantage of publicly held companies is that they bring together capital and managerial expertise, to the benefit of both groups. An investor need not know anything about making or marketing chairs in order to invest in a chair factory. A gifted producer or seller of chairs need not have capital in order to start a business. When it runs well, both profit, and the capitalist system achieves its goals. Our system of capitalism has been less successful when the company does not run well. As some of America's most visible, powerful, and successful companies began to slide, they demonstrated an all-but fatal weakness in the ability of our system to react in time to prevent disaster. Managers and directors at companies like IBM, General Motors, and Sears took their success--and their customers--for granted. They took their investors for granted, too, until it was almost too late. The problem is that the strength of the system, the separation of ownership and control, is also its weakness. A shareholder's investment in a chair factory gives him certain rights, including the right to elect the directors and the right to inspect the books. These rights may have some meaning when the company is small enough that the investors number in the hundreds. But in large, complex companies, with investors in the millions, they are likely to exercise a third right, the right to sell. While some economists will argue sale of the stock sends a signficant message to management, I agree with Edward Jay Epstein, who said that "just the exchange of one powerless shareholder for another in a corporation, while it may lessen the market price of shares, will not dislodge management--or even threaten it. On th... ...illing the vacancies left by the directors "fired" in the 1991 shrinkage. Ironically, Sears was left with a board with a higher percentage of outside directors. I believe Brennan found that at least some of the extra accountability I was seeking was the result of the actions he took to stop me. Less than six months after the annual meeting, Sears announced a massive restructuring. Coldwell Banker would be sold off in its entirety, Dean Witter would be spun off to shareholders, as would 20 percent of Allstate. The market reacted to the news by sending Sears' stock up 8 percent in a single day. Changes at Sears I firmly believe that Sears' recent renaissance (STOCK PRICES) is a direct result of the increased accountability of management. I believe that Sears serves as a perfect study for the values to be generated by involved and informed shareholders.

Harlem’s darkness and hardships

Baldwin’s â€Å"Sonny’s Blues† is a story of the two brothers living in Harlem. Harlem is the place where the two brothers experienced the darkness of the society. This darkness points out racism and drug abuse as one of the major problems experiencing by many African-American in Harlem. Even though racism was felt by the two brothers and drug abuse hunted Sonny, one of the two brothers, they still managed to adopt and survive through the help of each other. At the beginning of the story, the older brother is on his way to work as a schoolteacher.As he travels down the road, he also reads the newspaper and found out that his brother was caught dealing with heroine. Even before, Sonny was suspected by his older brother of using illegal drugs but the older brother does nothing. Before the drug related incident happens, the older brother who is also the narrator of the story always talks about Sonny as being a good brother. He says â€Å"When Sonny was young, his f ace was bright and open†. Sonny’s brother worries about the involvement of Sonny in illegal drugs.Sonny is being dependent on drugs and uses it as a way to escape his problems. This problem makes his brother think of the things he did wrong to make Sonny involved in drug addiction. As a result of that, the brother misinterprets all the acts Sonny is doing. He does not listen to Sonny even if it has to be about the explanation and reasons of why Sonny engaged to drug related activities. Sonny finds himself neglected by his brother. This makes him think that no one could help him but his own self. Realizing this, he diverts his attention to music.This involvement to music makes him finds the relief he is searching for. With the music playing, Sonny is able to escape the problems he is encountering. The improvement of Sonny is hardly noticed by his brother. At first, his involvement to music disappoints his brother not until his brother realizes the changes music has done to Sonny. His brother accepts the truth and realizes that music has done a good job to Sonny’s development. It all happened in the part of the story where his brother is listening to Sonny as he plays the piano.As Sonny plays the piano, his brother feels that Sonny need his guidance and love. The unconditional love by the brother to Sonny was depicted in the story. Listening to the Jazz music played by Sonny, the attitude of the brother towards life, himself and Sonny changes. The estrangement of the two brothers hurt them both. Sonny’s dedication to music and his determination to stay away from any form of illegal drugs move the older brother to change. The love and passion of both brothers are shown in the story.Their fight against the darkness in Harlem made them realize that to win is to accept the weakness of each one of them and to be able to survive is to help each other. As a final point, to be able to survive in a society where you are not the main character, you must learn to adapt and to help others that are also adapting. The challenges of Black American brothers in the time of racism and its fight against illegal drugs can be solve if trust, acceptance and love is within the family ties.

American politics essays

American politics essays The United States is as we all know a very diverse nation. People from all walks of life come to America in hopes for a better life. The government is then looked to, to provide that better life for the American citizen. We have the right as free citizens to put who we want into office. Although the government is faced with many important decisions, we turn to them to make the right ones. The dimensions used in the political gauges are similar for all four of the quizzes. On the first quiz your answers could fit into a liberals, a moderates, or a conservatives point of view. The second quiz was much more in depth and at the end we were presented with a grid. The red dot told us where we stand. We could be social economic libertarian or social economic authoritarian. The third quiz was very short it only concerned common personal and economic issues. Your score was mapped out on a diamond with one of the five following results: libertarian, left-liberal, centrist, right conservative, or statist. The fourth quiz scored your answers much like the second one. Except this time you could be a fiscal/non-fiscal liberal/conservative. In general, I believe they measure not only a persons political stand, but could also reflect the persons personality as well. The things that we are taught in life often shape our political views. We can take this information along with our own thoughts and decide on our political preference. All four of the tests I took measured me almost the same. I am proud of my views and where I stand. I believe the second quiz provided the best non-biased measure, because it was the longest and the most in depth. There were 5 choices you could pick from, so you got the most accurate scored. Unfortunately, other quizzes lacked the selection of answers. I could tell when I was taking the test that I would have a pretty good idea of how they would define me. My ...