Chinese Government and Media Essay Example | Topics and Well Written Essays - 2500 words

Chinese Government and Media - Essay Example This was a move that solicited negative remarks form a large number of Chinese more so in the Diaspora. According to this report, Chinese living in Canberra voiced their complaints against Taiwan's attempt to make themselves independent of the rest of China. The Chinese in Diaspora added that the only Group that had a right to represent China in the UN was the Chinese government. Xinhaunet claimed that a large number of independent Chinese bodies oppose Taiwan's move to seek independent representation. Some of them included Australian Capital Territory, Federation of Chinese independence and Chinese Australian cultural exchange. Additionally, Chinese in the Philippines also express their opposition of the Taiwan's move. The report further adds some of the views held by representatives of this body. Their views mostly highlight the government's position on the matter. For instance, there are references to the benefits that will come out of unification of different straits in China. These proponents assert that unification of Taiwan with the rest of China will prosper the economy. As if this is not enough, it will promote peace in the region. Assertions made by the Taiwanese leader to seek independent representation will only threaten peace in the region. ... They asserted that Taiwan is a fundamental part of China and no single force can claim to separate from the rest of China. They also believe that if Taiwan is to seek representation, then all one point six billion Chinese should be given the opportunity to decide their future. Chen-the Taiwanese leader, outraged this latter group. They called this move a trick and claimed that there was indeed no room for discussion. It is very interesting to note that mot of the sentiments in the report mostly back up the government's stand point on the issue. One can clearly see that the speakers and groups chosen were government friendly. Their remarks were rather harsh but these were used as a tool to voice the Chinese government's standpoint. It is quite possible to find other Chinese groups that opposed the government standpoint. Nevertheless, such sentiments have no place in a government owned media outlet. Most of the information portrayed above indicates the fact that government owned media outlets normally report one-sided stories. There is very little controversy in this article and this is characteristic that is common among many other newspaper outlets in the country. Tibet Issues It is very clear that Xinhaunet supports the government's view on the Tibetan issue. This is especially in relation to their recent media releases. On 27th March 2008, Xinhua reported that the Chinese president was to meet with the United States president to discuss the Tibetan issue. The report affirms US support. It quotes the sentiments expressed by President Bush that they believe in the unification of China and that there is only one China. Additionally, the report also adds the Chinese presidents' views on the matter. President asserts that thy

Bowlbys research Essay Example for Free

Bowlbys research Essay The maternal deprivation hypothesis was developed in post second world wartime and Bowlbys research was based on children that were extremely traumatized, having possibly lost both parents at war. As a result a lot of children ended up in institutions which more than likely had substandard conditions and numerous untrained carers. It is very important to bear in mind the context of that time as there was a national need for family life to be recreated and stabilised after the war. Thus, Bowlbys maternal deprivation hypothesis was interpreted as an opposition to the employment of women with young children and therefore the use of day-care facilities. It is important to acknowledge that Bowlby was primarily concerned with the welfare of children and that his theory of maternal deprivation played a huge role in reforming child care practices by pointing out the damaging effect of been cared for by numerous staff. In the years since however, the maternal deprivation hypothesis has been largely discredited in light of subsequent research which suggests that some separation, for example some time in a high quality day-care, may not necessarily have long-term effects on future relationships. Bowlbys monotropic model of attachment has also been highly criticised as recent evidence is revealing that children do form attachments with more than one adult, in particular with fathers, siblings and other adult carers with whom they have developed a stable relationship. Research has shown that children generally favour their fathers company to the company of a stranger. According to Lewis (1986) the attachment bond between a father and child is dependant on the quality of their relationship, that is, a child with a sensitive father that is focused on their needs will develop a stronger attachment bond with them. Nonetheless, in times of distress infants are more likely to seek out the comfort of their mother over their father (Lamb, 1981). Given the changing times and the steady increase in the proportion of working mothers, it is necessary to focus more on the effects of multiple attachments and specifically to the childs relationship with adult caregivers other than parents and relatives. Studies however, carried out by Tizard and Rees (1975) and Tizard and Hodges (1978) caution that while children can be cared for and attached to more than one adult, having a large number of caregivers may have an adverse effect on their ability to develop close relationships. Bowlbys maternal deprivation hypothesis was further developed by the work of Mary Ainsworth (1969), who devised a method for observing and assessing the attachment behaviour babies display towards their mothers/caregivers. This is known as the Strange Situation (ED209 TV4 programme) and is essentially a method for measuring a one year-olds attachment to its mother and assessing how the child reacts to separation and more importantly to reunion with its mother when placed in a slightly stressful situation. Briefly, the experiment involves taking mother and child to a strange room and observing the childs responses to the introduction of a stranger, the mothers departure, reunion with the mother, leaving the child alone for a few minutes in the room (most stressful event), and leaving the child alone with the stranger. Researchers classify the maternal-child attachment relationship based on the childs behaviour during reunion with the mother. Ainsworth suggests that attachment relations fall into three categories: securely attached, insecure-avoidant and insecure-ambivalent infants. Sometimes an additional category (disorganised) has been used. According to Ainsworth securely attached infants explore freely when their mother is present and use her as a secure base when a stranger appears. They greet her warmly on reunion and show a clear preference for her over the stranger. Children who do not behave this way, for example by clinging (insecure-ambivalent) or been more detached (insecure-avoidant) during reunion with their mother, are described as insecurely attached. Ainsworth et al (1978) believed that children who are separated from their mother, for example children who attend day-care, are likely to form insecure attachments. This is supported by Belsky (1988) who, it is interesting to note, revised his conclusions regarding the consequences of placing children in non-maternal day-care. Initially, he believed that day care did not effect a childs attachment to his/her mother, however subsequently in his review of a number of US studies, he concluded that children who are subjected to more than twenty hours a week of non-maternal day-care in their first year of life are at risk of developing insecure attachments. It is important to note that although the strange situation technique has been widely used by Belsky and others to assess the quality of a childs attachment to its caregiver, it may not however be the best method for comparing children who experience day care with those who do not. Belskys conclusions regarding day-care have been disputed by Clark-Stewart (1988) who argues that the differences in attachment styles between infants attending non-maternal day-care for less than twenty hours a week and more than 20 hours a week are not large enough to conclude that working mothers put their children at risk of suffering from psychological problems. Furthermore, she points out that children who attend day care are used to separation and therefore react differently on reunion with their mothers than children who are with their mothers all day. Thus, children may appear detached not because they are insecure but because they are more independent and more accustomed to been separated from their mother (Clark-Stewart, 1988) . Like Bowlby, Ainsworth believed in a universal model of attachment however, evidence from cross-cultural research on secure and insecure attachments carried out by Van Ijzendoorn and Kroonenberg (1988) revealed cultural differences in the mother-child relationship. This evidence questions the validity of using the strange situation method to measure and compare attachment in different cultures. For example, children from Japan showed intense distress in the strange situation when separated from their mother, as in their culture children are never left alone at twelve months. These cultural differences highlight the importance of moving away from a universal model of attachment towards a more cultural perspective. Bowlbys ethnocentric perspective, which sees the biological mother as the all-important person for the infants first attachment, has received a lot of criticism and has been branded as a Western cultural construction by some psychologists. It is interesting to note that out of 186 non-industrial societies Weisner and Gallimore (1977) found that, in only five of these societies was the child (almost) solely looked after by the mother! Moreover, research carried out in different countries showed the grandmother as having a special and unique attachment to the child due to her long life experience and wisdom (Tyszowka, 1991) thereby lending support to a more polyadic model of attachment.

Threat from Naturalised Wildflowers on Roadside Verges

Threat from Naturalised Wildflowers on Roadside Verges The Threat from Naturalised Wildflowers used on Roadside Verges for Native Forests and Agriculture. The naturalised vascular species of flora throughout New Zealand at present has similar totals to the native species (Williams Cameron, 2006), and newly naturalised species are being discovered at an increasing rate (Howell, 2008). Approximately 19% of all naturalised species are presently recorded as environmental weeds (Howell, 2008). Unfortunately, these statistics can, incorrectly, give the impression that New Zealand environments are inundated with an abundance of diverse weeds. Rather, the majority of naturalised plants, together with weeds, still inhabit a mere fraction of the wild-land habitats throughout New Zealand (Williams Wiser, 2004). In the centuries to come, it is predicted that weeds and other naturalised floras will increasingly occupancy areas of New Zealand, even for millenniums as has appeared to have occurred with Europe’s naturalised plants (Pysek Jarosik, 2005). The general origins of naturalised flora species were as decorative garden and feature pl ants (Howell, 2008), as such they commonly are present near human settlements (Timmins Williams, 1991). When random wild-land sites were surveyed few, if any, environmental weed species are generally found (Sullivan, Williams, Timmins, 2006). This suggests that environmental weeds are generally in the initial stages of infiltration into New Zealand’s environments, thus, there is an opportunity to curb further dispersal. Methods of long distance dispersal differ among environmental weed and naturalised flora species, however, the planting and sowing of naturalised flora species, particularly the wildflower varieties, on roadside verges both facilitates the establishment and acts as corridors for the dispersal agents of these species, for instance stock, people, and vehicles (Overton, Smale, Whaley, Fitzgerald, McGlone, 2002). It has been estimated that the naturalised flora species which are present along roadsides are disproportionately early naturalisations that were originally stock-dispersed, and from either or both recent or current agricultural use. The total richness of naturalised flora species on roadside verges can be reflective of habitat and aspects of the neighbouring land use (Ullman, Bannister, Wilson, 1998). Roadside verges, as well as riparian margins and various other ‘waste’ areas, contain patches of wild habitats that can act as reservoirs for naturalised flora species in what is otherwise intensively managed rural environments. However, some studies are indecisive when it comes to naturalised flora species utilising roadside verges as linear dispersal corridors autonomously of the neighbouring land. Rather, naturalised flora populations along roadside verges generally imitate the adjacent land and the naturalised flora communities present on that land. However, there wil l certainly be exceptions to this rule. One example in New Zealand is the Kaffir lily (Schizostylis coccinea) present in mid-Canterbury. This lily is spreading beside roads utilising the irrigation ditches (Webb, Sykes, Garnock-Jones, 1988). Roadside verges present an unusual, generally uninterrupted continuity of a mono-habitat. Given the variety of wild habitats that roads pass through, it is thought that this is indicative of a present absence of nearby sources that can be used for the purpose of propagating, or a propagule, for these species in the area. The role of propagule pressure at local scales in species distributions is well detailed by Levine (2001) in a related riparian structure (Levine, 2001). However, it is vague as to whether various ornamental naturalised flora species that are restricted to roadside verges could maintain their populations without the support of propagules from proximate cultivated sources, especially when it comes to competition from species that are more abundant, such as pastoral grasses, which disperse onto the roadside verges from the neighbouring land. Regardless of the typical dominance of species from neighbouring environments, roadside verges are not merely expansions of adjacent habitats (Angold, 1997) (Parendes Jones, 2000). Roadside verges are frequently continuously disturbed and possess altered soil conditions, particularly in close proximity to the traffic lane. They typically have high light availability, specifically verges next to high-traffic roads (Parendes Jones, 2000). This makes the proximal roadside zone a highly specialised habitat, which in the temperate zones of the Southern Hemisphere is normally occupied by ruderal, or pioneer, flora species generally originating in Eurasia, but they vary with regards to local climatic conditions (Wilson, Rapson, Sykes, Watkins, Williams, 1992). Over in Australia, tropical grasses often establish on roadside verges and before spreading into neighbouring open woodland (Amor Stevens, 1976). Generally, woody varieties of naturalised flora are more uncommon on roadside verges than herbaceous species; however, species such as pines and eucalypts (Healey, 1969) can be frequent on roadside verges, provided there is consistent available moisture and low disturbance rates. Such species as Cotoneaster spp. tend to be most common on roadside batters, which are generally less disturbed by roadside maintenance than the flat areas (Sullivan, Williams, Timmins, Smale, 2009). Naturalised plant species that are present on roadside verges can endure there as wild populations, yet they still may not infiltrate into the surrounding areas of agriculture and native environments. It is possible that filtering effects may be especially strong in climatically severe locations, even where the neighbouring short flora could give the impression that it is open to invasion. Herbaceous roadside naturalised flora are likely to be ephemerals, and are not able to penetrate neighbouring native vegetation, whereas successful invaders are inclined to be less ephemeral (Winqvist, 2003) and functionally similar to native species (Godfree, Lepschi, Mallinson, 2004). When it comes to prairie flora with a mix of native and naturalised ruderal species, the naturalised species are more likely to occur on roadsides than the native species (Larson, 2002). It is possible that similar patterns occur within New Zealand; however, ruderal species either native (Wardle, 1991) or naturalis ed on roadside verges are uncommon. On the other hand, where filtering effects are not as strong, the distribution of naturalised flora along roadside verges may alternatively suggest the initial stages of an invasion into the adjacent flora. In Europe, herbaceous flora could possibly be invaded from 50 to 100m from the roadside verge (Tyser Worley, 1992) and non-native evergreen woody species in the United States, invaded deciduous forests 120m from the roadside verge plantings (Foreman Deblinger, 2000). The effects of planting roadside verges with naturalised plants is exemplified in a study conducted by Sullivan, Williams, Timmins, Smale (2009) regarding the extent of Russell lupins (Lupinus polyphyllus) which has spread from gravelly roadside verges of the Mackenzie Basin into the adjacent degraded tussock grassland, riverbeds will also function similar to roads as key linear corridors for the spreading of plants (Sullivan, Williams, Timmins, Smale, 2009). In other circumstances, the discrepancy between naturalised flora on roadside verges and the neighbouring flora may be rather noticeable. Ruderal species are often limited to roadside verges or, for brief distances, into the neighbouring disturbed woodland in environments both different (Wester Juvik, 1983) and comparable to New Zealand (Pauchard Alaback, 2004). Whilst generally the Eurasian ruderal species do not establish within New Zealand forests, and it is more likely that the roadside verges will be invaded by shrubs and vines that possess comparable features to the native flora present (Williams, Nicol, Newfield, 2001). Within New Zealand naturalised flora on roadside verges are influenced by both climatic and altitudinal gradients (Wilson, Rapson, Sykes, Watkins, Williams, 1992) (Ullman, Bannister, Wilson, 1995). As the environmental responses are comparable to the responses documented in Europe, it has been recommended that establishment of all obtainable roadside verge sites by the naturalised species has occurred, regardless of the comparatively short time-span since their introduction to New Zealand (Ullman, Bannister, Wilson, 1995). However, this is unlikely to be true for all naturalised flora within New Zealand as generally there is a strong correlation concerning the time from naturalisation and habitation on roadside verges, as well as for the reason that there are numerous new naturalisations found on roadside verges (Williams Cameron, 2006). Roadside verges regularly offer the primary and closest opportunity for naturalised plants to establish past the restrictions of agriculture in what is an intensively managed landscape. 25% of recent naturalisations between 1989 and 2000 were gathered from roadside verges (Williams Cameron, 2006); though in part this is because of some sampling bias. The formation of an environment which naturalised flora will find favourable initiates with the construction of the road itself (Greenberg, Crownover, Gordon, 1997). A frequent effect of road construction is an elevation in the levels of the water-table on roadsides which aids the establishment of naturalised flora particularly in wetlands (Buckley, Crow, Nauertz, Schulz, 2003), whereas in more arid areas, the runoff delivers water and/or nutrients which then promotes the growth of naturalised flora (Williams Groves, 1980) more so than with natives (Angold, 1997). More often than not in New Zealand (Ullman, Bannister, Wilson, 1998), as well as in other parts of the world, naturalised grass species are some of the more commonplace roadside verge species (Tyser Worley, 1992), as the altered environment and roadside management is beneficial for them, more so than some of the other naturalised plant species, for instance woody species (Angold, 1997). In Westland, New Zealand, within the pakihi vegetation, the construction of roads has assisted the establishment and coverage of naturalised species by altering drainage patterns (as is the case with Carex ovalis) as well as increasing nutrient availability due to the soil disturbance (as with Holcus lanatus) (Williams, Courtney, Glenny, Hall, Mew, 1990). Roads themselves offer a way of accessing the land for a variety of modes of transportation from large vehicles to animals, and all may transport the seeds of various flora which are then deposited either haphazardly or specifically in various locations. Thus, it is possible for a species to invade more rapidly along roadside verges than across the landscape overall (Guthrie-Smith, 1953). This is indicated by the naturalised flora diversity and abundance found along the more developed roads (Tyser Worley, 1992) where the volume of traffic is greater, though the more developed roads may also possess a more altered and more regularly disturbed habitat along the roadside verge, as well as a higher density of human habitations. A mode of dispersal for various seeds and whole seed heads is the capability to be transported via some form of attachment, particularly to vehicles, specifically the smaller seeds which can be transported by the tyres of vehicles and in the soil itself that is a dhered to them (Schmidt, 1989). As a result, the seeds present on vehicles can originate from various habitats, and a small number of these species, comparatively, are found on roadside verges, yet the seeds of most naturalised species found on roadside verges are also persent on vehicles (Schmidt, 1989). Vehicles are capable of transporting not just the small seeds of naturalised flora species, which are more commonly than not grass species, but urban garden species as well which are generally wind dispersed (for instance Buddleja davidii) or dispersed via animals (such as Pyracantha spp.) (Wardle, 1991). The manner in which vehicles act as dispersal agents can be of particular concern to managers of natural areas, for example, in Kakadu National Park, they have found the seeds of roadside weeds in the tyres as well as the mud on vehicles (Lonsdale Lane, 1994). Unfortunately, a traditional method of washing cars is merely cosmetic, and does nothing to stop the spread of naturalised species via vehicles. As a result it is improbable that something can be done regarding seeds on private vehicles except in special circumstances, the most effective method to protect sensitive areas is to keep vehicles out altogether (Parendes Jones, 2000). Alternatively the approach of disregarding the dispersal vectors altogether and focusing on discovering the originating populations of naturalised species in sensitive areas (Lonsdale Lane, 1994) is possibly the best tactic in New Zealand, however, this may be unreasonable for locating naturalised species that have been spread by four-wheel-drive or ‘off road’ vehicles on tracks away from established roads. People who not only use roads but also the methods employed to maintain roads, principally the use ‘slashers’ on the roadside, are significant vectors for dispersal of naturalised species on roadside verges. Naturalised flora species are particularly dependent on these practices for their vegetative spread, species such as domestic hops (Humulus lupulus) within the Buller catchment, Nelson (Sullivan, Williams, Timmins, Smale, 2009). However, domestic stock is still the primary vector responsible for the dispersal of naturalised agricultural seed species in other parts of the world (Tyser Worley, 1992) (Pauchard Alaback, 2004), because they were preceded the introduction of stock transportation vehicles in New Zealand (Guthrie-Smith, 1953). While currently stock droving is not really practised within New Zealand, it is still possible for stock to disperse the seeds of naturalised species when they get transferred around (Tyser Worley, 1992). For naturalised species of flora to be actively planted and sowed on roadside verges, for the use in methods such as erosion control and even via the dumping of garden waste, has resulted in some significant invasions of flora, for example in the United States, Japanese honeysuckle (Lonicera japonica) was used on roadside verges for erosion control and bank stabilisation. However, it quickly became a problem due to its rapid growth rate and capability to displace native plant species (Williams, Timmins, Smith, Downey, 2001). Japanese honeysuckle is also a problem in New Zealand (DOC, 2014). Russell lupin (Lupinus polyphyllus) is another species commonly found on roadside verges throughout New Zealand and presents a threat to native areas. As they are an aggressive species presenting a particular threat to Canterburys braided riverbeds, with the potential impacts it could have these ecosystems. Roadside verges are among the areas of habitat suitable for use by environmental weeds and naturalised flora species as they advance their invasions into areas of natural vegetation within New Zealand’s landscape. Consequently, the protection of New Zealand’s sensitive and valuable conservation reserves from invasion by environmental weeds and naturalised flora species would definitely be advantaged by the control of planting and sowing roadside verges with naturalised wildflowers, particularly when used in combination with other weed control methods in neighbouring habitats that would be suitable for naturalised species. Carrie Page

French Revolution Essay -- essays research papers

The French Revolution lasted from 1789 to 1799. Although there were several factors that made the French Revolution possible, such as population growth, the expansion of the middle classes, and the rise of an informed public, there were three immediate causes of the Revolution. One was the diminished authority of the royal government. Another was the revolt by the nobility, who sensed a weakening monarchy. The third cause was the crop failure. The government of France was in a financial crisis. The country was deeply in debt from the financing of the wars of Louis XIV. To deal with the nation’s economic problems, Louis XVI called for a meeting of the Estates General in 1789. The Estates General was made up of representatives from each of the three social classes, or Estates. The First Estate consisted of the clergy, the Second Estate consisted of the nobility, and the Third Estate consisted of the commoners. The Third Estate, which made up 98 percent of the population of France, was underrepresented. Since the Estates General had to vote separately and by order, the Third Estate would almost always be outvoted by the First Estate and the Second Estate who would get to vote first. Because of this, the Third Estate wanted its traditional number of representatives to be doubled so that it matched the other two orders put together. When Louis XVI refused their demand, the Third Estate, led by Abbe Emmanuel Sieyes, changed its name to the Nation...

Occupy Wall Street Movement

Krystal Graham â€Å"Occupy Wall Street† Business Ethics Professor: Steven Curry â€Å"Occupy Wall Street† The â€Å"Occupy Wall Street† movement has become a big deal since it began in the fall of 2011. This movement was inspired by international protests, with thousands arriving in New York City answering the call, soon spreading to well over 500 cities. I would like to discuss more of the details of the movement, the moral and economic implications, as well as the different ethics theories to see which theory best applies to the movement.The Arab Springs protest on February 11, 2011 was the most notable inspiration of the Occupy Wall Street movement. According to the website occupy together, the occupy movement is an international movement driven by individuals. They are organized in over 100 cities in the United States, and they aim to fight back against the system that has allowed the rich to get richer and the poor to get poorer. All of us have many differe nt backgrounds and political beliefs but feel that, since we can no longer trust our elected officials to represent anyone other than their wealthiest donors, we need real people to create real change from the bottom up†¦ We no longer want the wealthiest to hold all the power, to write the rules governing an unbalanced and inequitable global economy, and thus foreclosing on our future. The movement works to achieve their goals by resist, In the spirit and tradition of civil disobedience #occupy takes to the streets to protest corporate greed, abuse of power, and growing economic disparity; Restructure, #occupy empowers individuals to lead others into action by gathering in the commons as engaged citizens to demonstrate a culture based on community and mutual aid. We will be the change we are seeking in the world; and finally, Remix work to make fundamental changes in the system.Now that we know a little more about the movement itself, let us look at some of the moral and econom ic implications of this movement. In the Constitution, the Fourteenth Amendment requires that the government provide â€Å"equal protection of the laws† to all citizens. The moral implications of the Occupy Wall Street movement reach far beyond the passing sensation it has created. The movement seems to be acquiring immunity from the laws the rest of us are expected to obey by calling themselves representatives of the 99 percent against the 1 percent.If 99 percent of the people in the country were like the Occupy mobs we would have anarchy, not a country. Democracy means majority rule, not mob rule, and if Occupy or any other mob movement actually represents the majority, they would have enough votes to legally achieve what they are trying to accomplish by illegal means. In problems of collective action, individuals who work solely for their own selfish interests can bring about tragic consequences for society as a whole. The only way for collective action problems to be solv ed is to create coordinated collaborations that unite social and individual interests.The â€Å"collective† element is paramount because even one â€Å"defector† (someone who acts selfishly, like those who stand accused of criminal acts at Occupy Wall Street camps) has the power to run everything by leading others to defect as well. I found an example of the Occupy movement being about the law on the national review website. â€Å"When trespassers blocking other people at the University of California-Davis refused to disperse and locked their arms with one another to prevent the police from being able to physically remove them, police finally resorted to pepper spray to break up this human logjam.The result? The police have been strongly criticized for enforcing the law. Apparently pepper spray is unpleasant, and people who break the law are not supposed to have unpleasant things done to them. Which is to say, we need to take the â€Å"enforcement† out of †Å"law enforcement. † The police are the last line of defense against barbarism, but they are equipped only to handle that minority who are not stopped by the first line of defense, moral principles. If everyone takes the path of least resistance, then the moral infrastructure will corrode and crumble.The moral infrastructure is one of the intangibles without which the tangibles don’t work. Like the physical infrastructure, its neglect in the short run invites disaster in the long run. Examples of real, measurable Occupy inspired change in the political sphere are hard to come by, though a band of millionaires did storm Capital Hill on Wednesday November 16, according to an article by the Associated Press to urge Congress to tax them more, claiming they are not paying their â€Å"fair share. The financial crisis caused a deep recession in our economy, and there are many individuals who are struggling to make ends meet and to get a job and to live their lives given the e conomic difficulties. I think there is an understandable frustration with the difficult economic circumstances that many families are experiencing now and a desire for change. There is one cost associated with Occupy Wall Street that is readily available, and that is the cost incurred by police as they patrolled the movement, originally in a watchdog status, and eventually as they cleared protestors from parks throughout the country.According to the Associated Press, as of November 24, taxpayers had paid at least $13 million in police overtime and municipal services. This includes $7 million in New York and $2. 4 million in Oakland, which faces a budget gap of $58 million this year. Utilitarianism is the moral doctrine that we should always act to produce the greatest possible balance of good over bad for everyone affected by our actions. The interests of the community are simply the sum of the interest of its members. An action promotes the interests of an individual when it adds t o the individual’s pleasure or diminishes the person’s pain.There are six points that need to be considered about utilitarianism. First, when deciding which action will produce the greatest happiness, we must consider unhappiness or pain as well happiness. Second, actions affect people to different degrees. Third, because utilitarians evaluate actions according to their consequences and because actions produce different results in different circumstances, almost anything might in principle, be morally right in some particular situation. Fourth, utilitarians wish to maximize happiness not simply immediately but in the long run as well.Fifth, utilitarians acknowledge that we often do not know with certainty what the future consequences of our actions will be. Finally, when choosing among possible actions, utilitarianism does not require us to disregard our own pleasure, nor should we give it added weight. Immanuel Kant sought moral principles that do not rest on continge ncies and that define actions as inherently right or wrong apart from any particular circumstances. He believed that moral rules can, in principle, be known as a result of reason lone and are not based on observation. Kantian theory uses the categorical imperative which says that we can will the maxim of our action to become a universal law. By maxim, Kant meant the subjective principle of an action, the principle that people in effect formulate in determining their conduct. Another way of looking at the categorical imperative is universal acceptability. Each person, through his or her own acts of will, legislates the moral law. Because reason is the same for all rational beings, we all give ourselves the same moral law.In other words, when you answer the question â€Å"What should I do? † you must consider what all rational beings should do. You can embrace something as a moral law only if all other rational beings can also embrace it. It must have universal acceptability. I n addition to the principle of universal acceptability, Kant explicitly offered another, very famous way of formulating the core idea of his categorical imperative. According to this formulation, as rational creatures we should always treat other rational creatures as ends in themselves and never as only means to our ends.Virtue ethics is identified as the one that emphasizes the virtues, or moral character, in contrast to the approach which emphasizes duties or rules or that which emphasizes the consequences of actions. Out of the theories, utilitarian, Kantian, and virtue ethics, I believe the Occupy Wall Street movement tries to follow the utilitarian theory. The movement is attempting to end the relationship built on money and donations between our elected officials and corporate interests.They want a system that operates in the interest of the people and to empower people to be a part of the process. They say they represent the 99 percent, and trying to make a change to have eq ual distribution of wealth for the country, which is what they feel is the best interest of the country as a whole. The income inequality and unequal wealth distribution in the United States is something that has been building over time and is not really any one person or companies fault. Many of the wealthy have earned the money by working hard to get to where they are now.There are many issues involved in the wealth distribution in our country, including that many of the poor have gotten poorer due to the lack of jobs as well as the fact that many of the mortgage companies allowed people to get into more debt by handing out home loans to people who wanted to purchase homes way out of their price ranges. This is also the fault of the people who got themselves into those positions. I am not sure if there is an equitable outcome from this movement, but I am sure this movement will continue, and if not, there will be another movement similar to this one.

Nano Station M2/M5 Loco Manual

Models: NanoStation M2/M5 NanoStation Loco M2/M5/M900 Introduction Introduction Thank you for purchasing a Nanostation M series product. This is a point-to-point CPE wireless device. This Quick Start Guide is for use with the following models: Model NanoStation M2 NanoStation M5 NanoStation Loco M2 NanoStation Loco M5 NanoStation Loco M900 Operating Frequency 2403-2475 MHz 5170-5875 MHz* 2402-2482 MHz 5170-5875 MHz* 904-926 MHz Ethernet Ports 2 2 1 1 1 * Only 5745-5850 MHz is supported in the USA and Canada Package Contents UB I NE T UB I ET ITI N QU RKS WO ITI N QU UB I NE T UB I ET ITI N QURKS WO ITI N QU NanoStation 24v PoE Adapter Power Cord Mounting Ties * Products may be different from pictures and are subject to change without notice. Installation Requirements †¢ 10 mm wrench †¢ Shielded Category 5 (or above) cabling should be used for all wired Ethernet connections and should be grounded through the AC ground of the PoE. We recommend that you protect your networks f rom the most brutal environments and devastating ESD attacks with industrial-grade shielded Ethernet cable from Ubiquiti Networks. For more details, visit www. ubnt. com/toughcable 1 Quick Start GuideHardware Overview Secondary Ethernet Port* * Secondary Ethernet Port included only on NanoStation M2 & M5 Secondary Main Reset Main Ethernet Port Note: Secondary Ethernet Port is capable of 24V Power over Ethernet output which can provide power to a secondary device. It can be enabled using the AirOS interface. LEDs LAN1 LAN2 Power The Power LED will light steady green when properly connected to a power source. LAN1 WAN/Main Ethernet The LAN1 Ethernet LED will light steady green when an active Ethernet connection is made to the Primary Ethernet Port and flash when there is activity.LAN/Secondary Ethernet The LAN2 Ethernet LED (on NanoStation M2/M5 only) will light steady green when an active Ethernet connection is made to the Secondary Ethernet Port. Signal These LEDs display the signal strength. LAN2 2 Typical Deployment Typical Deployment Connect the Power Cord to the PoE Adapter and a power outlet LAN or Computer to Ethernet Port labeled LAN on PoE Adapter Ethernet Port on Ubiquiti Device to Ethernet Port labeled POE on PoE Adapter Note: Shielded Category 5 (or above) cabling should be used for all wired Ethernet connections and should be grounded through the AC ground of the PoE. Quick Start Guide Accessing AirOS 1. Make sure that your host machine is connected via Ethernet to the Ubiquiti Networks device (as shown on previous page). 2. Configure the Ethernet adapter on your host system with a static IP address on the 192. 168. 1. x subnet (e. g. 192. 168. 1. 100). 3. Launch your Web browser and type http://192. 168. 1. 20 in the address field and press enter (PC) or return (Mac). 4. Enter ubnt in the Username and Password fields. Select your country from the Select Your Country drop-down. To use the product you must agree to the terms of use.To do so, click I agree to these terms of use. Click Login. 5. The AirOS Interface will appear allowing you to customize your settings as needed. 4 Ubiquiti Networks Wiki and Forum Ubiquiti Networks Wiki and Forum Ubiquiti Networks has an online Wiki with Manuals, Guides, and Information. It is located at www. ubnt. com/wiki. Another great resource is the Ubiquiti Networks Forum. You can post and view comments, questions, and answers with other forum members and Ubiquiti staff at www. ubnt. com/forum. 5 Quick Start Guide Installer Compliance ResponsibilityDevices must be professionally installed and it is the professional installer's responsibility to make sure the device is operated within local country regulatory requirements. Since Ubiquiti Networks equipment can be paired with a variety of antennas and cables, the Antenna Gain, Cable Loss, and Output Power fields are provided to the professional installer to assist in meeting regulatory requirements. Note: This product is locked to the US Countr y Code to ensure compliance with FCC regulations. 6 Specifications Specifications NanoStation MEnclosure Size Weight Max Power Consumption Power Supply Power Method Operating Temperature Operating Frequency M2 M5 Networking Interface 2403 MHz – 2475 MHz 5470 MHz – 5825 MHz 2 10/100BASE-TX Ethernet Ports 29. 4 x 8 x 3 cm 0. 5 kg 8 Watts 24V, 1A PoE Supply Included Passive PoE (Pairs 4, 5+; 7,8 return) -30 ° to 75 ° C NanoStation Loco M Enclosure Size Weight Max Power Consumption Power Supply Power Method Operating Temperature Operating Frequency Loco M900 Loco M2 Loco M5 Networking Interface 904 – 926 MHz 2412 MHz – 2462 MHz 5470 MHz – 5825 MHz 1 10/100BASE-TX Ethernet Ports 163 x 31 x80 mm 0. 8kg 5. 5 Watts 24V, 0. 5A PoE Supply Included Passive PoE (Pairs 4, 5+; 7,8 return) -30 ° to 80 ° C 7 Quick Start Guide Safety Notices 1. Read, follow, and keep these instructions. 2. Heed all warnings. 3. Only use attachments/accessories specified by the manufacturer. WARNING: Do not use this product in location that can be submerged by water. WARNING: Avoid using this product during an electrical storm. There may be a remote risk of electric shock from lightning. Electrical Safety Information 1.Compliance is required with respect to voltage, frequency, and current requirements indicated on the manufacturer’s label. Connection to a different power source than those specified may result in improper operation, damage to the equipment or pose a fire hazard if the limitations are not followed. 2. There are no operator serviceable parts inside this equipment. Service should be provided only by a qualified service technician. 3. This equipment is provided with a detachable power cord which has an integral safety ground wire intended for connection to a grounded safety outlet. . Do not substitute the power cord with one that is not the provided approved type. Never use an adapter plug to connect to a 2-wire outlet as this will d efeat the continuity of the grounding wire. b. The equipment requires the use of the ground wire as a part of the safety certification, modification or misuse can provide a shock hazard that can result in serious injury or death. c. Contact a qualified electrician or the manufacturer if there are questions about the installation prior to connecting the equipment. 8 General Warranty General WarrantyUBIQUITI NETWORKS, Inc (â€Å"UBIQUITI NETWORKS†) represents and warrants that the Products furnished hereunder shall be free from defects in material and workmanship for a period of one (1) year from the date of shipment by UBIQUITI NETWORKS under normal use and operation. UBIQUITI NETWORKS sole and exclusive obligation under the foregoing warranty shall be to repair or replace, at its option, any defective Product that fails during the warranty period. The expense of removal and reinstallation of any item is not included in this warranty.The foregoing warranty is exclusive and in lieu of all other warranties, express or implied, including the implied warranties of merchantability and fitness for a particular purpose and any warranties arising from a course of dealing, usage or trade practice with respect to the products. Repair or replacement in the manner provided herein shall be the sole and exclusive remedy of Buyer for breach of warranty and shall constitute fulfillment of all liabilities of UBIQUITI NETWORKS with respect to the quality and performance of the Products.UBIQUITI NETWORKS reserves the right to inspect all defective Products (which must be returned by Buyer to UBIQUITI NETWORKS factory freight prepaid). No Products will be accepted for replacement or repair without obtaining a Return Materials Authorization (RMA) number from UBIQUITI NETWORKS. Products returned without an RMA number will not be processed and will be returned to Buyer freight collect. UBIQUITI NETWORKS shall have no obligation to make repairs or replacement necessitated by ca tastrophe, fault, negligence, misuse, abuse, or accident by Buyer, Buyer’s customers or any other parties. The warranty period of any repaired or replaced.Product shall not extend beyond its original term. Warranty Conditions The foregoing warranty shall apply only if: (I) (II) The Product has not been subjected to misuse, neglect or unusual physical, electrical or electromagnetic stress, or some other type of accident. No modification, alteration or addition has been made to the Product by persons other than UBIQUITI NETWORKS or UBIQUITI NETWORK’S authorized representatives or otherwise approved by UBIQUITI NETWORKS. The Product has been properly installed and used at all times in accordance, and in all material respects, with the applicable Product documentation.All Ethernet cabling runs use CAT5 (or above) shielded cabling. (III) (IV) Disclaimer: UBIQUITI NETWORKS does not warrant that the operation of the products is error-free or that operation will be uninterrupt ed. In no event shall UBIQUITI NETWORKS be responsible for damages or claims of any nature or description relating to system performance, including coverage, buyer’s selection of products for buyer’s application and/or failure of products to meet government or regulatory requirements. Returns In the unlikely event a defect occurs, please work through the dealer or distributor from which this product was purchased. 9 Compliance ComplianceFCC Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. NOTE: This equipment has been tested and found to comply with the limits for a Class A digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment. This equipment generates, uses, and can radiate radio frequency energy and, if not installed and used in accordance with the instruction manual, may cause harmful interference to radio communications.Operations of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense. For MPE and antenna usage details, please visit our website at www. ubnt. com/compliance Industry Canada Under Industry Canada regulations, this radio transmitter may only operate using an antenna of a type and maximum (or lesser) gain approved for the transmitter by Industry Canada. To reduce potential radio inteference to other users, the antenna type and its gain should be so chosen that the equivalent isotropically radiated power (e. . r. p. ) is not more than that permitted for successful communication. This device complies with Industry Canada licence-exempt RSS standard(s). Operation is subject to the following two conditions: 1. This device may not cause interference, and 2. This device must accep t any interference, including interference that may cause undesired operation of the device. En vertu des reglements d'Industrie Canada, cet emetteur radio ne peut fonctionner avec une antenne d'un type et un maximum (ou moins) approuves pour gagner de l'emetteur par Industrie Canada.Pour reduire le risque d'interference aux autres utilisateurs, l'antenne type et son gain doivent etre choisies de facon que l'equivalent puissance isotrope rayonnee equivalente (pire) n'est pas plus que cela autorise pour une communication reussie. Et Cet appareil est conforme a la norme RSS Industrie Canada exempts de licence norme (s). Son fonctionnement est soumis aux deux conditions suivantes: 1. Cet appareil ne peut pas provoquer d'interferences et 2. Cet appareil doit accepter toute interference, y compris les interferences susceptibles de provoquer un fonctionnement du dispositif. 10 ComplianceRF Exposure Warning The transceiver described here emits radio frequency energy. Although the power lev el is low, the concentrated energy from a directional antenna may pose a health hazard. Do not allow people to come closer than 55. 53 cm to the antenna when the transmitter is operating. Additional information on RF exposure is available on the Internet at www. fcc. gov/oet/info/documents/bulletins L'emetteur-recepteur decrit ici emet de l'energie de frequence radio. Bien que le niveau de puissance est faible, l'energie concentree a partir d'une antenne directionnelle peut presenter un danger pour la sante.Ne pas permettre aux gens de se rapprocher de 55. 53 cm a l'antenne lorsque l'emetteur est en marche. Des renseignements supplementaires sur l'exposition aux RF est disponible sur Internet a www. fcc. gov/oet/info/documents/bulletins CE Marking CE marking on this product represents the product is in compliance with all directives that are applicable to it. Alert sign! Follows CE marking Alert sign must be indicated if a restriction on use applied to the product and it must follow the CE marking. NB-Identification number (if there is any) Notified body number is indicated if it is involved in the conformity assessment procedure.Please check the CE mark on the product label to find out which notified body was involved during assessment. 11 English We recommend that you protect your networks from the most brutal environments and devastating ESD attacks with industrial-grade shielded Ethernet cable from Ubiquiti Networks. For more details, visit www. ubnt. com/toughcable Deutsch Schutzen Sie Ihre Netzwerke vor extremen Umwelteinflussen und verheerender elektrostatischer Entladung (ESD), indem Sie abgeschirmte Ethernetkabel in Unternehmensqualitat von Ubiquiti Networks verwenden. Weitere Informationen erhalten Sie unter www. bnt. com/toughcable Espanol Le recomendamos que proteja sus redes de los entornos mas hostiles y los devastadores efectos de las descargas electrostaticas utilizando cable Ethernet blindado con calidad-industrial de Ubiquiti Networks. Para o btener mas informacion, visite www. ubnt. com/toughcable Francais Nous vous recommandons de proteger vos reseaux contre les environnements les plus brutaux et les decharges electrostatiques les plus devastatrices avec un cable Ethernet Ubiquiti Networks avec blindage renforce. Pour en savoir plus, rendez-vous sur www. ubnt. com/toughcableItaliano Si consiglia di proteggere le reti dagli ambienti e dagli attacchi ESD piu invasivi con il cavo Ethernet schermato-di tipo industriale di Ubiquiti Networks. Per ulteriori informazioni, visitare il sito Web www. ubnt. com/toughcable RR062111 Ubiquiti Networks Support Email: [email  protected] com Phone (9 a. m. – 5 p. m. PST): 408-942-1153 Online Resources Wiki Page: www. ubnt. com/wiki Support Forum: www. ubnt. com/forum Knowledge Base: www. ubnt. com/kb Downloads: www. ubnt. com/support/downloads www. ubnt. com  © 2011 Ubiquiti Networks, Inc. All rights reserved.

Macro Marketing Environment and the Sa Airline Industry Essays

Macro Marketing Environment and the Sa Airline Industry Essays Macro Marketing Environment and the Sa Airline Industry Paper Macro Marketing Environment and the Sa Airline Industry Paper There is a positive outlook on the Airline Industry as long as the political environment is stable. Due to positive policies and passing of laws hat support economic growth such as Liberations of sky regulatory frameworks as well as tax policies and consumer policies assures an inspiring sign in the industry. Increased competition due to various market offers by different players in the industry. This requires Low cost airlines like Mango to be more innovative in order to retain as well as gain new clients for their services. A times when policies and aviation regulation become strict it entails airlines such as Mango Economizer to the wider economy and include economic growth rates, levels of employment and unemployment, cost of raw terrestrial such as energy, fuels and inputs for production, interest rates, monetary policies, exchange rates and inflation rates. Economic growth is a guaranty of more and more travels within the country and as well as international travels by both locals and foreigners. Exchange rates are in favor of the rand and low inflation meaning more disposable income results in income growth and high volumes of business for the airline industry. But, of late due to the economic downturn since 2008 this has had a negative impact on the industry. Low cost airlines such as Mango have to come up tit effective business strategies that ensure cost effectiveness in operation cost as well increase in price for the services they offer in order to maintain their customer relations as well as gain new ones. They can be affected by increase in fuel and energy prices meaning they have to find more cost effective energy sources as well as come up with cost effective flight schedules. Refer to the rate of new inventions and development, changes in information and mobile technology, changes in internet and e-commerce and government spending on research. Further involves development of materials, new methods of manufacture, distribution and logistics. Due to environmental awareness issues such as going green there is need the use of more environmentally friendly fuels and energies. Industry will ensure high cost in a bid to ensure this. Climate change results in unpredictable weather patterns which in turn causes a disruption in Flight scheduling. Airing like Mango have to look for alternative forms of natural resources that promote environmental preservation that are also cost effective. Eight schedules can be charted around a study of new weather patterns.

From Bookstore to Theater, Turning Your Book into a Movie

From Bookstore to Theater, Turning Your Book into a Movie After years of research, writing and submitting, your book is published. Your dream is a reality. But through the process you had another dream – to see your written words come to life as a movie.   There are two routes to making this possible. Your first option is to find a literary agent to represent your book in the entertainment industry. The industry loves â€Å"IP† (intellectual property). From the Marvel universe to The Hunger Games, this is an industry that â€Å"hungers† for the next big thing, and they prefer to find those through agents.   Agents are flooded with submissions, but if your book has a following, reviews, and positive press, it may be considered for representation. Finding such an agent follows the same path used to find an agent for your book- research. To get a feel for the industry you’ll want to start reading industry trades The Hollywood Reporter and Variety. You should already know aboutIMDb.com (Internet Movie Database), and the monthly subscription toIMDbPro.com has fairly up-to-date contact information (you’ll see who representsSuzanne Collins, author of The Hunger Games).   Identify the agent’s submission policy. It’s all about that first impression. If you are fortunate enough to secure an agent, and they get your work optioned, then the process moves into higher gear.   Generally, you will receive an upfront payment for a specific time period of optioned rights. You may or may not have input into the adaptation of your book into a screenplay. If your book is not produced Your second option is to produce your own movie. This means a substantial learning curve and working with a team of creatives. To start, you adapt your book into a screenplay, which is easier said than done. As a novelist you adjust your thinking because a screenplay only paints what needs to be visualized. Start reading IndieWire.com and FilmmakerMagazine.com for a feel of the industry. Attend film festivals to see independent films come to life.   See if your state has a film office. Through all these new resources you may come across a screenwriter to work with.   The Writers Guild of America is also a wonderful resource. Want to write the screenplay yourself? I highly recommend the software Final Draft. With your script complete, submit to festivals with screenwriting competitions (FilmFreeway.com). Winning nominations and awards validates your screenplay.   Find the right cast and crew, which can be a challenge. Seek out local colleges or universities that offer a film program and castings for independent short and feature films. Volunteer to help on set or, if you’re interested in acting – audition! From there you will learn what happens on a set. Carefully plan your film budgets to include distribution. Shane Carruth’s award winning Primer was produced for $7,000 with a box office gross of over $400,000. Look him up to see where he is now. You probably once thought that publishing a book was just a dream, but there it is in your hands. If you apply the same discipline, determination and patience to the film industry, you may find yourself in a theater watching your book unfold on the silver screen.

Australian Competition and Connection Consumer Commission

Coles is a huge brand in Australia and the provisions of the Competition and Consumer Act, 2010, (Cth) apply on the company. To meet with the regulatory compliance of this act, Coles has opted for a few strategies. These strategies include providing better shopping experience to its customers, improving the quality by use of fresher produce and offering better value by lowering the prices of weekly shopping basket. The Annual Report of Coles for the financial year 2015 stated its objectives as delivering a better store network; focus on freshness and creating trusted value. By supplying better quality products, Coles is working towards creating trusted value. Coles Online is a part of the company which also shares the same strategy of providing better services, by making shopping easy for its customers. This strategy has a clear and strong focus on delivering savings to its customers. Coles Express had introduced trusted Every Day Value pricing in its stores for fulfillment of this strategy (Coles, 2015). The slogans of the company, used from time to time are aligned with the, objectives of the Act. Whether it is the slogan used in 1980s of â€Å"You'll find the best value is at Coles New World"  or the one used from 1998 to 2003, which was "Serving you better†, Coles has ensured that the objectives of the Act are met. The current slogan of the company â€Å"Down Down† promotes competition (Mortimer, 2015). The strategies of Coles seem plain advertisement criteria, but a careful observation of the wordings clarifies the objective behind these strategies. The Act, through its various provisions, provides that a business has to ensure that the produce provided to the consumers, is safe for human consumption. Further, the products which have a low shelf life have to be provided to the customers, within the shelf life of such product. The act also provides that the inertest of the consumer have to be secured. All the strategies of Coles reflect the objective of the Competition and Consumer Act, 2010. The objective of this Act is to enhance the welfare of the Australians by promoting competition, free trading and providing provisions for consumer protection (Australian Government, 2016). The strategy of Coles is to provide fresher products to its customers. By providing fresher produce, the company sets examples to its competitors to ensure that the consumers ultimately benefit from its business. A better store network would ensure that the customers do not face any hassles in their shopping experience. One of the strategies of Coles is to provide better products at lower values. By ensuring a combination of better product with low costs, a sense of competition is attained. The other companies would also move towards providing such services. The consumer would get better products at lesser prices. This would again promote competition. Coles had its share of problems with the Australian Competition and Consumer Commission. The Court in the case of ACCC v Coles Supermarkets Australia Pty Ltd [2014] FCA 1405 held that the company was engaged in unconscionable conduct and levied a penalty of $10 million on it (Australian Competition and Consumer Commission, 2014). The judge held that the misconduct of Coles was deliberate, repeated and serious. Further, the judge held that the company had misused its bargaining power and the conduct of Coles was contrary to the conscience (Australian Competition Law, 2015). This created a huge problem for Coles as it failed on its strategies to promote competition. On the basis of above case, certain recommendations have been drafted for Coles to improve the management activities of the company, in order to comply with the competition law. The main recommendation for Coles is that, it has to ensure that the incidents mentioned in the above case are not repeated. It should conduct its business in a way which is considered as conscience. It should, at no instance, threaten to harm its suppliers who refused to comply with the Company’s demands. Coles has to promote fair trading in its business, along with promoting competition amongst the businesses. Coles has to ensure that it does not indulge in any sort of misleading and deceptive conduct. Further, as the unconscionable and misleading conduct has been prohibited through this Act, Coles has to make sure that it does not take part in such conduct. There has already been a case against Coles in this regard, and any more cases would mean that the company fails to achieve its strategies of creating trusted value. There is also scope of improvement in the management activities of the company to ensure compliance of competition law. The company is working towards providing fresher produce but by creating a better supply chain, the time of getting the produce from suppliers to the supermarket can be reduced. This would ensure that the consumers gets fresh produce and promotes competition. To conclude, it is recommended to the company that they follow the provisions of the Act strictly and ensure that the instances of unconscionable conduct are not repeated. Keeping in view the incident that occurred, the grounds for successful negligence along with the consequences to Bungee World Ltd (BW) have been enlightened here. Recommendations are also provided to resolve the potentially damaging public relations problem in the best possible way. Negligence is the civil wrong done where a duty of care was owed by a person towards another person and the person failed to fulfill this duty, which resulted in a loss or injury to the other person. To establish that the liability arose under the tort of negligence, certain elements have to be present. These elements include a duty of care, a breach of such duty of care, a loss or injury as a result of breach of the duty, and that the loss or injury has to be relevant and not too remote. As per the Civil Liability Act, 2002 (NSW), a person is not considered as negligent unless the risk was predictable, the risk was not at all insignificant and in similar circumstances a prudent person would have taken proper precautions. A landmark case in the duty of care is the case of Donoghue v Stevenson [1932] AC 562 (Boella and Pannett, 1999). Further, a standard of care has to be ensured as was seen in the case of Bathurst Regional Council v Thompson [2012] NSWCA 340 (Sheehan, 2012). Though a defense is available to the breaching party which states that, a person has to ensure his own safety when the risks are presumed. In such a case, the aggrieved party cannot sue the breaching party as they failed to take the duty of care for themselves. This was also established in the case of Mulligan v Coffs Harbour City Council (2005) 223 CLR (High Court of Australia, 2005). But, in the case of Rootes v Shelton (1967) 116 CLR 383, 385-6, the judge held that when the risk is inherent, the people are bound to accept it to engage in the risky sports (Swarb, 2016). And so, this cannot be referred as a defense by the breaching party. Damage is not only the physical damage, but also the emotional distress. In the case of Baltic Shipping v Dillon (1993) 176 CLR 344, it was held that the applicant could recover damages for the emotional distress that resulted from the breach of duty of care (Australian Contract Law, 2013). In the present case, BW was providing the services of Bungee Jumping for a fee of $50. Further, a waiver form had to be signed by the customers to undertake this activity. As has been established from the famous cases, this does not reduce the liability of BW in case of an injury. BW owed a duty of care towards Loki and had to ensure that the equipment for the bungee jumping was safe and secure. Further, the risk of corrosion was inherent due to the sea moisture present in the air. In this case, BW is liable for negligence as it breached the duty of care it owed to Loki. Further, as stated above, the injury does not have to be a physical and a mental injury is enough to claim damages under negligence. In this case, Loki did not suffer any physical injury but suffered a nervous shock. So, he can successfully sue BW for negligence. As a result of this negligence action taken by Loki, BW will be liable to pay Loki the monetary damages, as a remedy for the injury which Loki suffered. This is a potentially damaging public relations problem and so an effective crisis management is needed to resolve this problem. It is recommended to the Board that the problem should be assessed properly and an understanding should be gained regarding the potential stakeholder, which is Loki in this case. The Board should take steps in providing compensation to Loki before he takes any legal action. This would not only save the costs of legal proceedings, but also act as a shield against the damage done to Loki, as well as, to the image of the company. It is also recommended to the Board to ensure that the faulty equipment is changed and that all the old equipment is checked for its durability and safety. The Board should properly advertise the remedial actions taken as well as the voluntary compensation provided to Loki, so that the image of the company, in the eyes of the public, is improved. Lastly, it is recommended to the company formulate a proper crisis management team which can anticipate, identify and monitor such crisis which have a negated impact on the image of the company (Bernstein, 2016). The 10 minimum employment entitlements which are provided to the workers in Australia as per the Fair Works Act, 2009, are known as the National Employment Standards, or NES. An enterprise agreement or any other registered agreement, an employment contract, or an award are not allowed to provide such conditions, which are less than the NES or the national minimum wages. It can be rightly inferred that the NES and the national minimum wage cover the minimum entitlements for the workers in this country. The 10 minimum entitlements as are stated in the NES includes requests for flexible working arrangements; annual leave; maximum weekly hours; parental leave and related entitlements; long service leave; fair work information statement; personal careers leave and compassionate leave; community service leave; public holidays; and a notice of termination and redundancy pay (Fair Work Ombudsman, 2016). These standards apply to all such employees who are covered in the national workplace relations system by the NES, irrespective of the registered agreement, employment contract, or the award. Casual employees are also eligible to NES entitlements, when it relates to an unpaid compassionate leave, an unpaid carer’s leave, the Fair Work Information Statement, or the community service leave (Fair Work Ombudsman, 2016). The head of human resources of an Australian engineering company needs to ensure that the company does not contravene these standards. These standards contain that the maximum standard working week should be within the limits of 38 hours for any full time employee, along with the reasonable additional hours. It has to be ensured that the right to request some flexible working arrangement is present. The parental and adoption unpaid leave of 12 months should be available for the employees along with a right to seek an additional 12 months. The paid annual leave of four weeks should be available with the employees for each year, on pro rata basis (The Australian Workers’ Union, 2016). Further, a ten day paid personal or carer’s leave should be available with the employees for each year, on pro rata basis, along with two days unpaid carer’s leave for each permissible occasion, and two days paid compassionate leave for each permissible occasion. The head of HR also has to ensure that proper leaves for jury service, as well as, for emergencies and natural disasters are provided to its employees. Such person also has to ensure that the new employees receive the Fair Work Information Statement. The employees have to be entitled to take the public holidays and the entitlement be paid for ordinary hours for such days. Lastly, the long service leave and notice of termination as well as redundancy pay has to be made available (Fair Work Ombudsman, 2016). The section 3 of the Australian Consumer Law (ACL) defines the term consumer. A person who acquires goods or services and the amount paid for such goods or services does not exceed $40,000, is a consumer (Australasian Legal Information Institute, 2016). Such goods and services must be used for personal only and not for re-supply, to fall under the category of consumer. Further, Section 21 of the ACL contains provisions regarding unconscionable conduct in relation to the goods or services. Section 21(1) prohibits a person from supplying or acquiring goods and services, to or from, a person in a manner where the conduct is considered as unconscionable (Australian Competition Law, 2014). Though, the sections of ACL do not define what is considered as unconscionable conduct and hence, reliance is made to the Courts to consider whether an act can be termed as unconscionable conduct or not (Find Law Australia, 2016). The courts generally rely on the following points to consider the conduct as unconscionable conduct: the strength in the bargaining capabilities of the consumer and the supplier; if the consumer was required to comply with the conditions of the supplier, which were not reasonable in the interests of the consumer, and the supplier’s conduct had forced the consumer to comply with such conditions; whether or not the consumer had a clear understanding regarding the appropriate documents related to the supply of goods and services; whether the supplier exerted any pressure or undue influence on the consumer; and such circumstances where the consumer could have taken the goods or supplier from any other supplier. If a supplier is found guilty of contravening the section 21 of the ACL, such supplier is then liable to civil pecuniary penalties of $220,000 for persons (other than body corporate) and for body corporate the penalty amount is $1.1 million. Further, the enforcement powers and remedies can also be applied on the supplier for contravening this section. These include injunctions, damages, substantial notices, undertakings, infringement notices, and non-punitive orders, amongst the other things (Australian Consumer Law, 2013). As the sale of the Ono water filter amounted to $2000, Rebecca would be considered as a consumer under the ACL. Dave had used undue influence on Rebecca and forced her to purchase the filter. Further, he used his strength of bargaining position and forced Rebecca to waive the cooling off period. Rebecca had no need to purchase the filter but the unconscionable conduct of Dave compelled her to buy the filter. Hence, Dave contravened the sections of ACL and as a result, Rebecca has the right to seek compensation from Dave. Further, Dave is also liable to civil pecuniary penalties of $220,000. Australasian Legal Information Institute. (2016) Competition And Consumer Act 2010 - Schedule 2. [Online] Australasian Legal Information Institute. Available from: https://www.austlii.edu.au/au/legis/cth/consol_act/caca2010265/sch2.html [Accessed on: 20/09/16] Australian Competition and Consumer Commission. (2014) Court finds Coles engaged in unconscionable conduct and orders Coles pay $10 million penalties. [Online] Australian Competition and Consumer Commission. Available from: https://www.accc.gov.au/media-release/court-finds-coles-engaged-in-unconscionable-conduct-and-orders-coles-pay-10-million-penalties [Accessed on: 20/09/16] Australian Competition Law. (2014) Section 21: Unconscionable conduct in connection with goods or services. [Online] Australian Competition Law. Available from: https://www.australiancompetitionlaw.org/legislation/provisions/acl21.html [Accessed on: 20/09/16] Australian Competition Law. (2015) ACCC v Coles Supermarkets Australia Pty Ltd ACCC v Coles Supermarkets Australia Pty Ltd [2014] FCA 1405 (22 December 2014). [Online] Australian Competition Law. Available from: https://www.australiancompetitionlaw.org/cases/2014coles.html [Accessed on: 20/09/16] Australian Consumer Law. (2013) The Australian Consumer Law: A framework overview. [Online] Australian Government. Available from: https://consumerlaw.gov.au/files/2015/06/ACL_framework_overview.pdf [Accessed on: 20/09/16] Australian Contract Law. (2013) Baltic Shipping v Dillon High Court of Australia (1993) 176 CLR 344. [Online] Australian Contract Law. Available from: https://www.australiancontractlaw.com/cases/baltic.html [Accessed on: 20/09/16] Australian Government. (2016) Competition and Consumer Act 2010. [Online] Australian Government. Available from: https://www.legislation.gov.au/Details/C2011C00003/Html/Volume_1#param2 [Accessed on: 20/09/16] Bernstein, J. (2016) The 10 Steps of Crisis Communications. [Online] Bernstein Crisis Management. 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Financial Reporting and Analysis Essay Example | Topics and Well Written Essays - 1000 words - 2

Financial Reporting and Analysis - Essay Example n laid down by the IASB and the FASB together with the intension of providing a sound future for the accounting standards which have moved to becoming more principals based, internally consistent and internationally converged. This paper has also dealt with the pros and cons of this framework and the agreements are based around the ‘international’ conceptual framework. The IASB is a board which aims at developing and helping to improve the general purpose financial statements, to make sure that it meets to the public interest (Mill, et.al., 2003). The IASB is one of the single high qualities, simple to understand and also one of the only global accounting standards which needs complete information of the general purpose financial statements. The International Accounting Standard Board (IASB) has made various proposals to improve the conceptual framework for financial reporting. The International Accounting Standard Board has proposed to improvise the objectives of the General Purpose Financial Reports (Kitabjian, 2008). The International Accounting Standard Board has focused on improving the General Purpose Financial Reports for potential investors and lenders. They suggest that the report aims at these groups of individuals to help them make informed decisions regarding their capital investments (IASB, 2008). The IASB also works in cooperation wi th the national accounting standard setters which provides for a meeting point for all the accounting standards from across the world. The use of fair value as opposed to the historical cost accounting has always been quite a controversial choice. In this case the use of fair value would prove to be more beneficial when compared to the historical cost accounting as this would have reduced the impact of the credit crunch. In the time of a credit problem and a troubled economy, the use of fair value is one which is most beneficial. The use of fair value is beneficial majorly because the use of the fair value provides

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Radiation Protection for Angiography Procedure.

Radiation Protection for Angiography Procedure. Fluoroscopic procedure produces the greatest patient radiation exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure. a) Protection to Patient * A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on. * The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the user to the completion of the preset on time. This signal will remain on until the timing device is reset. * The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized. * Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding. * Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible. * Methods of limiting radiation exposure include: o making certain that the fluoroscopy unit is functioning properly through routine maintenance, o limiting fluoroscopic exposure time, o reducing fields of exposure through collimation, o keeping the X-ray source under the table by avoiding cross-table lateral visualization when possible, and o bringing the image intensifier down close to the patient b) Protection to personnel There are therefore three basic ways to minimize dose: * Reduce time of exposure * Use the inverse square law-doubling your distance away quarter your exposure * Use shielding by barrier These basics known as Cardinal Principle which is important to achieved ALARA. i) Time Radiation dose is directly proportional to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure. The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as follows: Exposure time = Exposure/Exposure rate Exposure = Exposure rate x time The algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small. Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure. ii) Distance The second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically as: where I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four. In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used. iii) Shielding Shielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible lead gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels. Shielding of occupational workers can be achieved by following methods: * Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical) * The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law). * Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields. Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary (scattered) radiation, not the primary beam. The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp. It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us. Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm. Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands; however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only. 2. State five clinical indications for the patient undergo the angiography procedure. 3. Explain the patient care management before, during and after the procedure Before a procedure: * Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure. * They must remove all jewelry before the procedure and change into a hospital gown. * If the arterial puncture is to be made in the armpit or groin area, shaving may be required. * A sedative may be administered to relax the patient for the procedure. * An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram. * Be aware of and follow all Local Rules and protocols * Prior to the angiography procedure, patients will be briefed on the details of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form. * Ensure that all exposures are justified and there is informed consent * Check patient identity * Position patient comfortably flat, with arm above head where possible * Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron * Check all staff are wearing radiation monitors correctly * Use all available lead shielding appropriately sited * Position table before screening * Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 – 90 kV is appropriate * Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient * Check all staff are as far away as possible in their role * Use dose reduction programmers when possible * Perform acquisitions on full inspiration where possible * Collimate closely to area of interest * Prolonged procedures: reduce dose to the irradiated skin eg. Change beam angulations * Minimize fluoroscopy time, high dose rate time and no of acquisitions * Remember software features, such as replay fluoro to minimize dose * Dont over use geometric magnification * Remove grid for small patients or when image intensifier / detector cannot be placed close to patient * Check and record screening time and DAP at the end of the case and review against the DRL. During the procedure: * The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter. * The radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. * When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities. * Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know. * Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels; this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV). After the procedure: * Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms. * If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released. * If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period. * The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for several weeks. * The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site. * Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately. * Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure. 4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure. * Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Â · Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique. 5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures. The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel. Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel. The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules. Technique Reduces Physician Radiation Exposure During Angiography Current technique requires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning. In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask; outside and inside the thyroid shield; on the right and left arm; outside and inside the lead apron; and on the right and left leg. The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques. Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia. Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients. It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram. New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this extension bar and lead plastic shield may be such a technique. Definition Angiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries. Purpose Angiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis; to diagnose heart disease; to evaluate kidney function and detect kidney cysts or tumors; to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain; and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neurosurgery. Precautions Patients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure. Description Angiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure. Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted. The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye. Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move. Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Because of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time. Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied. Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined below: Cerebral angiography Cerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete. Coronary angiography Coronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. Pulmonary angiography Pulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes. Kidney angiography Patients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour. Fluorescein angiography Fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour. Celiac and mesenteric angiography Celiac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied. Splenoportography A splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation. Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage. Aftercare Risks Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare. A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedures, and arrhythmias may develop. Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction. Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients. Normal results The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels. Abnormal results Abnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. Arteriosclerosis A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation. Carotid artery An artery located in the neck. Catheter A long, thin, flexible tube used in angiography to inject contrast material into the arteries. Cirrhosis A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension. Embolism A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal. Femoral artery An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography. Fluorescein dye An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography. Fluoroscopic screen A fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. Guide wire A wire that is inserted into an artery to guides a catheter to a certain location in the body. Iscehmia A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels. Necrosis Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. Plaque Fatty material that is deposited on the inside of the arterial wall. Portal hypertension A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach. Portal vein thrombosis The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension. For Your Information Books * Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed. Radiation Protection for Angiography Procedure. Radiation Protection for Angiography Procedure. Fluoroscopic procedure produces the greatest patient radiation exposure rate in diagnostic radiology. Therefore the radiation protection in fluoroscopy is very important. Several feature and techniques in fluoroscopy are designed for protection to the patient during fluoroscopic procedure. a) Protection to Patient * A dead-man switch is a device (switch) constructed so that a circuit closing contact can only be maintained by continuous pressure on the switch by the operator. Therefore, when the machine is turned on by any means, whether by the push button at the control panel, or by the foot pedal, this switch must be held in for the machine to remain on. * The on-time of the fluoroscopic tube must be controlled by a timing device, and must end alarm when the exposure exceeds 5 minutes. An audible signal must alert the user to the completion of the preset on time. This signal will remain on until the timing device is reset. * The X-ray tube used for fluoroscopic must not produce X-rays unless a barrier is in position to intercept the entire cross-section of the useful beam. The fluoroscopic imaging assembly must be provided with shielding sufficient that the scatter radiation from the useful beam is minimized. * Protective barriers of at least 0.25 mm lead equivalency must be used to attenuate scatter radiation above the tabletop. This shielding does not replace the lead garments worn by personnel. Scattered radiation under the table must be attenuated by at least 0.25 mm lead equivalency shielding. * Additionally, most c-arm fluoroscopes have a warning beeper or light that activate when the beam is on, some have both. Never inactivate any warning devices, and keep ones foot off the foot pedal whenever possible. * Methods of limiting radiation exposure include: o making certain that the fluoroscopy unit is functioning properly through routine maintenance, o limiting fluoroscopic exposure time, o reducing fields of exposure through collimation, o keeping the X-ray source under the table by avoiding cross-table lateral visualization when possible, and o bringing the image intensifier down close to the patient b) Protection to personnel There are therefore three basic ways to minimize dose: * Reduce time of exposure * Use the inverse square law-doubling your distance away quarter your exposure * Use shielding by barrier These basics known as Cardinal Principle which is important to achieved ALARA. i) Time Radiation dose is directly proportional to the time, those by doubling the radiation time the dose is doubled and by having the radiation time the doses halved. Many factors impact the on time of a fluoroscopic procedure. The exposure time is related to radiation exposure and exposure rate (exposure per unit time) as follows: Exposure time = Exposure/Exposure rate Exposure = Exposure rate x time The algebraic expressions simply imply that if the exposure time is kept short, then the resulting dose to the individual is small. Method of reducing exposure time include meticulous advanced planning of the procedure, judicious use of contrast enhancement, appropriate positioning of the patient, orientation of the fluoroscope unit prior to beginning the procedure. ii) Distance The second radiation protection action relates to the distance between the source of radiation and the exposed individual. The exposure to the individual decreases inversely as the square of the distance. This is known as the inverse square law, which is stated mathematically as: where I is the intensity of radiation and d is the distance between the radiation source and the exposed individual. For example, when the distance is doubled the exposure is reduced by a factor of four. In mobile radiography, where there is no fixed protective control booth, the technologist should remain at least 2 m from the patient, the x-ray tube, and the primary beam during the exposure. In this respect, the ICRP (1982), as well as the NCRP (1989a), recommended that the length of the exposure cord on mobile radiographic units be at least 2 m long. Another important consideration with respect to distance relates to the source-to-image receptor distance (SID). The appropriate SIDs for various examinations must always be maintained because an incorrect SID could mean a second exposure to the patient. Long SID results in less divergent beam and thus decreases the concentration of photons in the patients. Short SID results in the reverse action and increases the patient dose. Hence the longest possible SID should be employed in examinations. However, if a greater than standard SID is used then greater intensity of radiation would be required to produce the same film density. Therefore it is recommended that only standard SIDs should be used. iii) Shielding Shielding procedure the most utilitarian results in the reduction of staff dose as there are times when the procedure list simply must function in close proximity, even directly cines fluoroscopy. In these circumstances there simply is no substitute for the best modern flexible lead gloves, lead glasses, lightweight lead apron and lead lined thyroid shield available. Appropriate shielding is mandatory for the safe use of ionizing radiation for medical imaging. Other method of shielding includes beam collimation, protective drapes and panels. Shielding of occupational workers can be achieved by following methods: * Personnel should remain in the radiation environment only when necessary (step behind the control booth, or leave the room when practical) * The distance between the personnel and the patient should be maximized when practical as the intensity of radiation decreases as the square of distance (inverse square law). * Shielding apparel should be used as and when necessary which comprise of lead aprons, eye glasses with side shields, hand gloves and thyroid shields. Lead aprons are shielding apparel recommended for use by radiation workers. These are classified as a secondary barrier to the effects of ionizing radiation. These aprons protect an individual only from secondary (scattered) radiation, not the primary beam. The thickness of lead in the protective apparel determines the protection it provides. It is known that 0.25 mm lead thickness attenuates 66% of the beam at 75kVp and 1mm attenuates 99% of the beam at same kVp. It is recommended that for general purpose radiography the minimum thickness of lead equivalent in the protective apparel should be 0.5mm. It is recommended that women radiation workers should wear a customized lead apron that reaches below mid thigh level and wraps completely around the pelvis. This would eliminate an accidental exposure to a concept us. Other protective apparel included eye glasses with side shields, thyroid shields and hand gloves. The minimum protective lead equivalents in hand gloves and thyroid shields should be 0.5mm. Lead lined glass and thyroid shield likewise reduce 90% of the exposure to the eyes and thyroid respectively. Lead lined gloves reduce radiation exposure to the hands; however they are no substitute for strict observation of appropriate fluoroscopic hygiene. Gloves should be considered as an effective means of reducing scatter radiation only. 2. State five clinical indications for the patient undergo the angiography procedure. 3. Explain the patient care management before, during and after the procedure Before a procedure: * Patients undergoing an angiogram are advised to stop eating and drinking eight hours prior to the procedure. * They must remove all jewelry before the procedure and change into a hospital gown. * If the arterial puncture is to be made in the armpit or groin area, shaving may be required. * A sedative may be administered to relax the patient for the procedure. * An IV line will also be inserted into a vein in the patients arm before the procedure begins in case medication or blood products are required during the angiogram. * Be aware of and follow all Local Rules and protocols * Prior to the angiography procedure, patients will be briefed on the details of the test, the benefits and risks, and the possible complications involved, and asked to sign an informed consent form. * Ensure that all exposures are justified and there is informed consent * Check patient identity * Position patient comfortably flat, with arm above head where possible * Ensure all members of staff in room are wearing suitable. For operations this should be lead glasses, thyroid collar and wrap-around lead apron * Check all staff are wearing radiation monitors correctly * Use all available lead shielding appropriately sited * Position table before screening * Keep tube current as low as possible and kVp as high as possible for cardiac studies, 60 – 90 kV is appropriate * Keep x ray tube at maximum and image intensifier / receptor at minimum distance from patient * Check all staff are as far away as possible in their role * Use dose reduction programmers when possible * Perform acquisitions on full inspiration where possible * Collimate closely to area of interest * Prolonged procedures: reduce dose to the irradiated skin eg. Change beam angulations * Minimize fluoroscopy time, high dose rate time and no of acquisitions * Remember software features, such as replay fluoro to minimize dose * Dont over use geometric magnification * Remove grid for small patients or when image intensifier / detector cannot be placed close to patient * Check and record screening time and DAP at the end of the case and review against the DRL. During the procedure: * The radiologic technologist will position you on the exam table. A radiologist a physician who specializes in the diagnostic interpretation of medical images will administer a local anesthetic and then make a small nick in your skin so that a thin catheter can be inserted into an artery or vein. The catheter is a flexible, hollow tube about the size of a strand of spaghetti. It usually is inserted into an artery in your groin, although in some cases your arm or another site will be selected for the catheter. * The radiologist will ease the catheter into the artery or vein and gently guide it to the area under investigation. The radiologist will be able to watch the movement of the catheter on a fluoroscope, which is an x-ray unit combined with a television monitor. * When the catheter reaches the area under study, the contrast agent will be injected through the catheter. By watching the fluoroscope screen, the radiologist will be able to see the outline of your blood vessels and identify any blockages or other irregularities. * Angiography procedures can range in time from less than an hour to three hours or more. It is important that you relax and remain as still as possible during the examination. The radiologic technologist and radiologist will stay in the room with you throughout the procedure. If you experience any difficulty, let them know. * Angiography also can be performed using magnetic resonance instead of x-rays to produce images of the blood vessels; this procedure is known as magnetic resonance angiography (MRA) or magnetic resonance venography (MRV). After the procedure: * Because life-threatening internal bleeding is a possible complication of an arterial puncture, an overnight stay in the hospital is sometimes recommended following an angiography procedure, particularly with cerebral and coronary angiograms. * If the procedure is performed on an outpatient basis, the patient is typically kept under close observation for a period of at six to 12 hours before being released. * If the arterial puncture was performed in the femoral artery, the patient will be instructed to keep his leg straight and relatively immobile during the observation period. * The patients blood pressure and vital signs will be monitored and the puncture site observed closely. Pain medication may be prescribed if the patient is experiencing discomfort from the puncture, and a cold pack is applied to the site to reduce swelling. It is normal for the puncture site to be sore and bruised for several weeks. * The patient may also develop a hematoma, a hard mass created by the blood vessels broken during the procedure. Hematomas should be watched carefully, as they may indicate continued bleeding of the arterial puncture site. * Angiography patients are also advised to enjoy two to three days of rest and relaxation after the procedure in order to avoid placing any undue stress on the arterial puncture. Patients who experience continued bleeding or abnormal swelling of the puncture site, sudden dizziness, or chest pains in the days following an angiography procedure should seek medical attention immediately. * Patients undergoing a fluorescein angiography should not drive or expose their eyes to direct sunlight for 12 hours following the procedure. 4. Identify the type of contrast medium, the dose and delivering technique in angiography procedure. * Reducing radiation doses to the patient also generally reduces doses to the medical personnel. Â · Angiography procedure is using fluoroscopy imaging technique which is a real-time imaging technique. 5. List down the catheters and guide wires inclusive of size, shape and the hole type that are used in angiography procedures. The use of lead gloves during procedures is unusual as they are cumbersome and difficult to work in. The automatic brightness control will increase the exposure to go through two layers and one only protects the hand, so if they are going to be used a programme that sets the radiation factors rather than allowing adjustment may be appropriate. In practice, with careful collimation and attenuation to detail it should not necessary for the operators hand to be in the primary beam and only close to it for short periods. While doing catheterization, radiologist should do it behind the lead glass viewer which consists of lead equivalent glass of 0.25mm thickness. Geometric consideration is one of the important things in angiography because source of exposure to personnel is mainly from scattered radiation from the patient. So, it is important to minimize the amount of scattered radiation to personnel. This can be achieved by geometric consideration involving the x-ray tube, patient and image intensifier. The image intensifier should be as close as possible to patient to minimize the amount of scattered radiation hitting personnel. Because in angiography room is sterile for all things, personnel such as radiologist, nurses, radiographer or student should wear shoes which are prepared only. Make sure that film badges always outside personnel body to measure the dose receive to the personnel. The most important thing to remember is that all individuals should be fully trained and learned to be responsible for radiation safety. Involvement of a radiation expert is essential and is particularly useful in equipment specification, assessment and quality assurance, but also in the formulation of Local Rules. Technique Reduces Physician Radiation Exposure During Angiography Current technique requires that physicians performing radiation procedures wear lead gowns. The new technique involves use of a body length floor mounted lead plastic panel to protect to physicians as they monitor patients angiograms and control exam table movement. An extension bar allows the physician to remain safely behind the shield and still retain table control for panning. In the study, researchers recorded radiation exposure to various parts of a physicians body during 25 coronary angiography procedures and compared those results with radiation exposure during angiography on 25 patients using conventional radiation protection. A lead apron, thyroid shield, eyeglasses and facemask were used in both techniques, but a ceiling mounted shield was used in the conventional technique. The researchers placed radiation badges outside and inside the facemask; outside and inside the thyroid shield; on the right and left arm; outside and inside the lead apron; and on the right and left leg. The new equipment resulted in a 90 percent reduction in radiation exposure to the physicians head, arms, and legs. Exposure of the thyroid and torso was minimal with both techniques. Enhanced physician radiation protection during coronary angiography is readily achievable with this new technique, said Martin Magram, M.D., of the University of Maryland Medical Center in Baltimore, Md. Dr. Magram presented the study results on May 3 at the American Roentgen Ray Society Annual Meeting in Vancouver, British Columbia. Dr. Magram pointed out that by freeing physicians from the need to wear lead gowns, the new technique could preserve their ability to benefit patients. It may extend by years their ability to apply the skills they have developed over long careers of serving patients, noted Dr. Magram. New methods of radiation protection must parallel the development of new radiation techniques, added Dr. Magram. The key is to limit medical workers radiation exposure with effective and easy-to-use techniques, and the use of this extension bar and lead plastic shield may be such a technique. Definition Angiography is the x-ray study of the blood vessels. An angiogram uses a radiopaque substance, or dye, to make the blood vessels visible under x ray. Arteriography is a type of angiography that involves the study of the arteries. Purpose Angiography is used to detect abnormalities or blockages in the blood vessels (called occlusions) throughout the circulatory system and in some organs. The procedure is commonly used to identify atherosclerosis; to diagnose heart disease; to evaluate kidney function and detect kidney cysts or tumors; to detect an aneurysm (an abnormal bulge of an artery that can rupture leading to hemorrhage), tumor, blood clot, or arteriovenous malformations (abnormals tangles of arteries and veins) in the brain; and to diagnose problems with the retina of the eye. It is also used to give surgeons an accurate map of the heart prior to open-heart surgery, or of the brain prior to neurosurgery. Precautions Patients with kidney disease or injury may suffer further kidney damage from the contrast mediums used for angiography. Patients who have blood clotting problems, have a known allergy to contrast mediums, or are allergic to iodine, a component of some contrast mediums, may also not be suitable candidates for an angiography procedure. Because x rays carry risks of ionizing radiation exposure to the fetus, pregnant women are also advised to avoid this procedure. Description Angiography is usually performed at a hospital by a trained radiologist and assisting technician or nurse. It takes place in an x-ray or fluoroscopy suite, and for most types of angiograms, the patients vital signs will be monitored throughout the procedure. Angiography requires the injection of a contrast dye that makes the blood vessels visible to x ray. The dye is injected through a procedure known as arterial puncture. The puncture is usually made in the groin area, armpit, inside elbow, or neck. The site is cleaned with an antiseptic agent and injected with a local anesthetic. First, a small incision is made in the skin to help the needle pass. A needle containing an inner wire called a stylet is inserted through the skin into the artery. When the radiologist has punctured the artery with the needle, the stylet is removed and replaced with another long wire called a guide wire. It is normal for blood to spout out of the needle before the guide wire is inserted. The guide wire is fed through the outer needle into the artery and to the area that requires angiographic study. A fluoroscopic screen that displays a view of the patients vascular system is used to pilot the wire to the correct location. Once it is in position, the needle is removed and a catheter is slid over the length of the guide wire until it to reaches the area of study. The guide wire is removed and the catheter is left in place in preparation for the injection of the contrast medium, or dye. Depending on the type of angiography procedure being performed, the contrast medium is either injected by hand with a syringe or is mechanically injected with an automatic injector connected to the catheter. An automatic injector is used frequently because it is able to propel a large volume of dye very quickly to the angiogram site. The patient is warned that the injection will start, and instructed to remain very still. The injection causes some mild to moderate discomfort. Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain, but they usually last only momentarily. To view the area of study from different angles or perspectives, the patient may be asked to change positions several times, and subsequent dye injections may be administered. During any injection, the patient or the camera may move. Throughout the dye injection procedure, x-ray pictures and/or fluoroscopic pictures (or moving x rays) will be taken. Because of the high pressure of arterial blood flow, the dye will dissipate through the patients system quickly, so pictures must be taken in rapid succession. An automatic film changer is used because the manual changing of x-ray plates can eat up valuable time. Once the x rays are complete, the catheter is slowly and carefully removed from the patient. Pressure is applied to the site with a sandbag or other weight for 10-20 minutes in order for clotting to take place and the arterial puncture to reseal itself. A pressure bandage is then applied. Most angiograms follow the general procedures outlined above, but vary slightly depending on the area of the vascular system being studied. A variety of common angiography procedures are outlined below: Cerebral angiography Cerebral angiography is used to detect aneurysms, blood clots, and other vascular irregularities in the brain. The catheter is inserted into the femoral or carotid artery and the injected contrast medium travels through the blood vessels on the brain. Patients frequently experience headache, warmth, or a burning sensation in the head or neck during the injection portion of the procedure. A cerebral angiogram takes two to four hours to complete. Coronary angiography Coronary angiography is administered by a cardiologist with training in radiology or, occasionally, by a radiologist. The arterial puncture is typically given in the femoral artery, and the cardiologist uses a guide wire and catheter to perform a contrast injection and x-ray series on the coronary arteries. The catheter may also be placed in the left ventricle to examine the mitral and aortic valves of the heart. If the cardiologist requires a view of the right ventricle of the heart or of the tricuspid or pulmonic valves, the catheter will be inserted through a large vein and guided into the right ventricle. The catheter also serves the purpose of monitoring blood pressures in these different locations inside the heart. The angiogram procedure takes several hours, depending on the complexity of the procedure. Pulmonary angiography Pulmonary, or lung, angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism. The procedure differs from cerebral and coronary angiograms in that the guide wire and catheter are inserted into a vein instead of an artery, and are guided up through the chambers of the heart and into the pulmonary artery. Throughout the procedure, the patients vital signs are monitored to ensure that the catheter doesnt cause arrhythmias, or irregular heartbeats. The contrast medium is then injected into the pulmonary artery where it circulates through the lung capillaries. The test typically takes up to 90 minutes. Kidney angiography Patients with chronic renal disease or injury can suffer further damage to their kidneys from the contrast medium used in a kidney angiogram, yet they often require the test to evaluate kidney function. These patients should be well-hydrated with a intravenous saline drip before the procedure, and may benefit from available medications (e.g., dopamine) that help to protect the kidney from further injury due to contrast agents. During a kidney angiogram, the guide wire and catheter are inserted into the femoral artery in the groin area and advanced through the abdominal aorta, the main artery in the abdomen, and into the renal arteries. The procedure will take approximately one hour. Fluorescein angiography Fluorescein angiography is used to diagnose retinal problems and circulatory disorders. It is typically conducted as an outpatient procedure. The patients pupils are dilated with eye drops and he rests his chin and forehead against a bracing apparatus to keep it still. Sodium fluorescein dye is then injected with a syringe into a vein in the patients arm. The dye will travel through the patients body and into the blood vessels of the eye. The procedure does not require x rays. Instead, a rapid series of close-up photographs of the patients eyes are taken, one set immediately after the dye is injected, and a second set approximately 20 minutes later once the dye has moved through the patients vascular system. The entire procedure takes up to one hour. Celiac and mesenteric angiography Celiac and mesenteric angiography involves x-ray exploration of the celiac and mesenteric arteries, arterial branches of the abdominal aorta that supply blood to the abdomen and digestive system. The test is commonly used to detect aneurysm, thrombosis, and signs of ischemia in the celiac and mesenteric arteries, and to locate the source of gastrointestinal bleeding. It is also used in the diagnosis of a number of conditions, including portal hypertension, and cirrhosis. The procedure can take up to three hours, depending on the number of blood vessels studied. Splenoportography A splenoportograph is a variation of an angiogram that involves the injection of contrast medium directly into the spleen to view the splenic and portal veins. It is used to diagnose blockages in the splenic vein and portal vein thrombosis and to assess the strength and location of the vascular system prior to liver transplantation. Most angiography procedures are typically paid for by major medical insurance. Patients should check with their individual insurance plans to determine their coverage. Aftercare Risks Because angiography involves puncturing an artery, internal bleeding or hemorrhage are possible complications of the test. As with any invasive procedure, infection of the puncture site or bloodstream is also a risk, but this is rare. A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or artery. The heart may also become irritated by the movement of the catheter through its chambers during pulmonary and coronary angiography procedures, and arrhythmias may develop. Patients who develop an allergic reaction to the contrast medium used in angiography may experience a variety of symptoms, including swelling, difficulty breathing, heart failure, or a sudden drop in blood pressure. If the patient is aware of the allergy before the test is administered, certain medications can be administered at that time to counteract the reaction. Angiography involves minor exposure to radiation through the x rays and fluoroscopic guidance used in the procedure. Unless the patient is pregnant, or multiple radiological or fluoroscopic studies are required, the small dose of radiation incurred during a single procedure poses little risk. However, multiple studies requiring fluoroscopic exposure that are conducted in a short time period have been known to cause skin necrosis in some individuals. This risk can be minimized by careful monitoring and documentation of cumulative radiation doses administered to these patients. Normal results The results of an angiogram or arteriogram depend on the artery or organ system being examined. Generally, test results should display a normal and unimpeded flow of blood through the vascular system. Fluorescein angiography should result in no leakage of fluorescein dye through the retinal blood vessels. Abnormal results Abnormal results of an angiography may display a restricted blood vessel or arterial blood flow (ischemia) or an irregular placement or location of blood vessels. The results of an angiography vary widely by the type of procedure performed, and should be interpreted and explained to the patient by a trained radiologist. Arteriosclerosis A chronic condition characterized by thickening and hardening of the arteries and the build-up of plaque on the arterial walls. Arteriosclerosis can slow or impair blood circulation. Carotid artery An artery located in the neck. Catheter A long, thin, flexible tube used in angiography to inject contrast material into the arteries. Cirrhosis A condition characterized by the destruction of healthy liver tissue. A cirrhotic liver is scarred and cannot break down the proteins in the bloodstream. Cirrhosis is associated with portal hypertension. Embolism A blood clot, air bubble, or clot of foreign material that travels and blocks the flow of blood in an artery. When blood supply to a tissue or organ is blocked by an embolism, infarction, or death of the tissue the artery feeds, occurs. Without immediate and appropriate treatment, an embolism can be fatal. Femoral artery An artery located in the groin area that is the most frequently accessed site for arterial puncture in angiography. Fluorescein dye An orange dye used to illuminate the blood vessels of the retina in fluorescein angiography. Fluoroscopic screen A fluorescent screen which displays moving x-rays of the body. Fluoroscopy allows the radiologist to visualize the guide wire and catheter he is moving through the patients artery. Guide wire A wire that is inserted into an artery to guides a catheter to a certain location in the body. Iscehmia A lack of normal blood supply to a organ or body part because of blockages or constriction of the blood vessels. Necrosis Cellular or tissue death; skin necrosis may be caused by multiple, consecutive doses of radiation from fluoroscopic or x-ray procedures. Plaque Fatty material that is deposited on the inside of the arterial wall. Portal hypertension A condition caused by cirrhosis of the liver. It is characterized by impaired or reversed blood flow from the portal vein to the liver, an enlarged spleen, and dilated veins in the esophagus and stomach. Portal vein thrombosis The development of a blood clot in the vein that brings blood into the liver. Untreated portal vein thrombosis causes portal hypertension. For Your Information Books * Baum, Stanley, and Michael J. Pentecost, eds. Abrams Angiography. 4th ed.