Virtual Reality - What It Is And How It Works Essays (3112 words)

Virtual Reality - What it is and How it Works Imagine being able to point into the sky and fly. Or perhaps walk through space and connect molecules together. These are some of the dreams that have come with the invention of virtual reality. With the introduction of computers, numerous applications have been enhanced or created. The newest technology that is being tapped is that of artificial reality, or "virtual reality" (VR). When Morton Heilig first got a patent for his "Sensorama Simulator" in 1962, he had no idea that 30 years later people would still be trying to simulate reality and that they would be doing it so effectively. Jaron Lanier first coined the phrase "virtual reality" around 1989, and it has stuck ever since. Unfortunately, this catchy name has caused people to dream up incredible uses for this technology including using it as a sort of drug. This became evident when, among other people, Timothy Leary became interested in VR. This has also worried some of the researchers who are trying to create very real applications for medical, space, physical, chemical, and entertainment uses among other things. In order to create this alternate reality, however, you need to find ways to create the illusion of reality with a piece of machinery known as the computer. This is done with several computer-user interfaces used to simulate the senses. Among these, are stereoscopic glasses to make the simulated world look real, a 3D auditory display to give depth to sound, sensor lined gloves to simulate tactile feedback, and head-trackers to follow the orientation of the head. Since the technology is fairly young, these interfaces have not been perfected, making for a somewhat cartoonish simulated reality. Stereoscopic vision is probably the most important feature of VR because in real life, people rely mainly on vision to get places and do things. The eyes are approximately 6.5 centimeters apart, and allow you to have a full-colour, three-dimensional view of the world. Stereoscopy, in itself, is not a very new idea, but the new twist is trying to generate completely new images in real- time. In 1933, Sir Charles Wheatstone invented the first stereoscope with the same basic principle being used in today's head-mounted displays. Presenting different views to each eye gives the illusion of three dimensions. The glasses that are used today work by using what is called an "electronic shutter". The lenses of the glasses interleave the left-eye and right-eye views every thirtieth of a second. The shutters selectively block and admit views of the screen in sync with the interleaving, allowing the proper views to go into each eye. The problem with this method though is that you have to wear special glasses. Most VR researchers use complicated headsets, but it is possible to create stereoscopic three-dimensional images without them. One such way is through the use of lenticular lenses. These lenses, known since Herman Ives experimented with them in 1930, allow one to take two images, cut them into thin vertical slices and interleave them in precise order (also called multiplexing) and put cylinder shaped lenses in front of them so that when you look into them directly, the images correspond with each eye. This illusion of depth is based on what is called binocular parallax. Another problem that is solved is that which occurs when one turns their head. Nearby objects appear to move more than distant objects. This is called motion parallax. Lenticular screens can show users the proper stereo images when moving their heads well when a head- motion sensor is used to adjust the effect. Sound is another important part of daily life, and thus must be simulated well in order to create artificial reality. Many scientists including Dr. Elizabeth Wenzel, a researcher at NASA, are convinced the 3D audio will be useful for scientific visualization and space applications in the ways the 3D video is somewhat limited. She has come up with an interesting use for virtual sound that would allow an astronaut to hear the state of their oxygen, or have an acoustical beacon that directs one to a trouble spot on a satellite. The "Convolvotron" is one such device that simulates the location of up to four audio channels with a sort of imaginary sphere surrounding the listener. This device takes into account that each person has specialized auditory signal processing, and personalizes what each person hears. Using a position sensor from Polhemus, another VR research company, it is possible to move the position of sound by simply moving a small cube around in your hand. The key to the Convolvotron is something called the "Head- Related Transfer Function (HRTF)", which is a set of mathematically modelable responses that

What to Do When a Possessive Blocks Punctuation

What to Do When a Possessive Blocks Punctuation What to Do When a Possessive Blocks Punctuation What to Do When a Possessive Blocks Punctuation By Mark Nichol When one refers to a city followed by the name of the state or a larger entity in which the city is located, the larger entity is set off from the smaller one by a pair of commas. But how do you treat such a reference when the place name is possessive? Revise the reference. A DailyWritingTips.com reader sent me this note: â€Å"I came across this in this morning’s New York Times: â€Å"In Portland, Oregon’s Pearl District, Dave Trausneck said he draws inspiration from the many states he has called home.† I suppose there should be a comma after Oregon’s but it sure would look hinky. It’s an awkward little phrase. What do you think? Should it be recast to read, â€Å"In the Pearl District, in Portland, Oregon, Dave Trausneck said he draws inspiration from the many states he has called home†? Oddly, as far as I know, this question is not resolved in any writing or editing handbooks, but some online commentators agree with the reader and me that a comma after Oregon would be quite hinky. But the New York Times usage, as she suggests, possesses some hinkiness of its own. I would change it with a revision similar to hers, but with a construction that reduces the comma count: â€Å"In the Pearl District of Portland, Oregon, Dave Trausneck said he draws inspiration from the many states he has called home.† A similar aberration appears in such sentences as â€Å"The Albany, New York-based company was founded in 1999.† Technically, the hyphen, to demonstrate that â€Å"New York,† not just York, is being attached to based as a phrasal adjective, should be an en dash, but that subtlety is lost on many readers (and writers). Regardless, it’s better to write around this style break: â€Å"The company, based in Albany, New York, was founded in 1999.† Alternatively, consider whether â€Å"based in† is superfluous it’s relevant only if the company is headquartered in Albany, New York, but has other locations and delete the phrase if appropriate: â€Å"The Albany, New York, company was founded in 1999.† Then there’s the intrusive insertion of a parenthesis between the possessive form of a name and the noun it refers to, as in â€Å"The law went into effect when Russia’s (then the Soviet Union) road use was not as heavy because fewer citizens owned vehicles.† Should â€Å"Soviet Union† also be possessive? No, because it’s a parenthetical insertion of the different name of the country during the period being referred to. But revise the syntax to avoid the possessive form altogether: â€Å"The law went into effect when road use in Russia (then the Soviet Union) was not as heavy because fewer citizens owned vehicles.† Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Style category, check our popular posts, or choose a related post below:15 Terms for Those Who Tell the FutureConnotations of 35 Words for Funny People40 Irregular Verbs That Can End in â€Å"-t†

7 Steps to Stop Overthinking Everything in Your Life

7 Steps to Stop Overthinking Everything in Your Life You know you do it. It takes you half an hour to decide which sandwich to order at lunch. A week to decide what to do with your weekend. Years to decide in which direction you want to take your career. You tell yourself just to make a darn decision, but as soon as you do the chorus of doubts and second-guessing starts. If you want to make faster and better life decisions, it’s important to stop overthinking everything in your life. Here are 7 excellent strategies for how to clear your head.1. Zoom out and look at the big pictureBe a bit more mindful and start observing your thoughts from a distance. Rather than getting all caught up in the moment, observe your process and try to take the panic out of it. Simply noticing the restlessness of your mind without being swept away by that can help.2. Write it downIf you don’t have someone to talk your options through with, you can always talk them through with yourself- at least on paper. You’ll be able to organize (and see) your thought process and perhaps see the situation much more clearly.3. Stop thinking so muchSometimes designating â€Å"no-thinking times† is the way to go. If you have trouble sleeping, for example, limit yourself to not thinking about stressful things after 8 p.m. Or, you could schedule specific thinking time (say in 20 minute sections) and try to keep the hamster wheel still the rest of your day. When your time is up, move on to something more productive and try again in your next designated time slot.4.  Walk away for a momentIt’s really hard to concentrate on two things at once. Distract yourself from mental torture by doing literally anything else. Find an absorbing activity and use it as a cure-all for depressed or stressed moments.5. Be proactiveBreak a thought spiral by taking proactive steps towards getting something done. Pick one thing you can do now and focus on that. Do that one thing. And whenever you find yourself worrying endlessly about the f uture, take a break and repeat.6. Listen to and trust yourselfYour own opinion matters. Respect it. Trust yourself to make the right choice. And let go of the doubts.7. Know you can change your mindEven if you do make the â€Å"wrong† choice, don’t despair. It’s not worth gnashing your teeth over a decision when you’re really just worried you won’t choose correctly. Take away that fear by realizing that, no matter what happens, you can always change the wrong decision and correct things. No decisions are final. So no decisions require agonizing deliberation.

The effective use of participatory action within public-private Dissertation

The effective use of participatory action within public-private partnership in the provision of housing for key workers bearing - Dissertation Example 6 2.3.1 Carrying field work for CSR †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 9 2.4 Sustainability in housing provision †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦.. 10 2.5 Conceptualising participation for both public and private sectors †¦Ã¢â‚¬ ¦. 13 3. Citizen power: The Ghana experience †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. .†¦Ã¢â‚¬ ¦...16 4. The Stakeholders †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦... 17 4.1 The Ministry of Works and Housing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦... 17 4.2 The World Bank †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦.. 18 4.3 The Home Finance Comp any †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦. 18 4.4 Strengthening Community management in the development and operation of facilities and services (SCMP) †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 19 4.5 Shack Dwellers International (SDI) †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦.. 20 5. Framework through participatory methods of stakeholders †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦.. 21 5.1 Ethical Issues Involved †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦... ... Assessment: What brings success to a PPP? †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦.. 33 8. References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦.. 38 1. Introduction Housing has become one of humanity’s basic needs. Without a roof over their heads, individuals become like nomads searching for their place where they can be pioneers, although nomads are different than refugees who flee ‘because they have no choice’ (Kaplan as cited in Buki, 2003, p. 24). In the so-called third world countries, especially Ghana, housing is one of the primary programs over which government makes decisions. Whether to alleviate poverty, to jumpstart the economy, or to improve the quality of life of the people, providing housing for the workers and ordinary employees with the support of the public and private sectors is a m ajor undertaking of a developing economy. (Mason 1996, p. 176) People in Ghana are not refugees; neither are they nomads. They value housing as basic human need but housing is a precious commodity that is difficult to grasp. In other words, post-colonial Ghana has relatively failed in its housing policy: the 1986 National Housing Policy and 1992 National Shelter Strategy both did not succeed (Obeng-Odoom 2013). However, several administrations have tried to put up housing programs for city residents, employing public-private partnerships although those are still in the implementation stage (Obeng-Odoom, p. 108). Housing leaders and experts have called for secondary mortgage solution to solve the growing problem of housing in Africa. Experts also recommended that the private sector, especially the banking industry, should provide financing in the form of home equity loans, to help solve the housing problem. (Obeng-Odoom 2013, p. 109)

Using Metaphors in Organizations Essay Example | Topics and Well Written Essays - 3500 words

Using Metaphors in Organizations - Essay Example This essay stresses that metaphorical way of looking at an organization is a very useful way of understanding the organization, developing new concepts and theories that can help in better management and growth of the organization. This can potentially have a very positive influence on the society and environment as well. The discussion above explains how two different metaphors for the same organization can create completely different perceptions and theories in terms of their operations, people, customers and stakeholders. This paper makes a conclusion that emphasis on metaphors can be considered as one of the oldest, most deeply embedded, even indispensable ways of knowing in the history of human consciousness and also form the basis of some of the most central ideas of understanding a concept. In fact, many theorists have agreed with the three reasons Ortony. These theories state that metaphors provide a compact version of an event; they enable people to predict characteristics that are unnamable, and; they are more vivid emotionally, sensorially and cognitively because they are close to perceived experience. In spite of the power embraced by metaphorical expressions, their exploitation creates lot of misunderstanding of the concept. The positive outcomes of metaphorical expression of organizations as brains can be attributed to the sophistication in information processing systems used by the organization, their capacity to handle huge data, and their ability to think and act strategically.

Management Of Acute Coronary Syndrome

Management Of Acute Coronary Syndrome Acute coronary syndrome encompasses a collection of three acute processes related to myocardial ischemia. These include: unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). Myocardial ischemia is caused by inadequate perfusion within the myocardial tissue due to oxygen demand exceeding oxygen supply. In a healthy person the amount of oxygen required by the myocardium (O2 demand) is determined by heart rate, myocardial contractility, myocardial wall stress, and afterload. As explained by Antman, et al (2012), oxygen supply to the myocardium requires a satisfactory level of oxygen-carrying capacity of the blood (determined by the inspired level of oxygen, pulmonary function, and hemoglobin concentration and function) and an adequate level of coronary blood flow. The coronary vessels have the ability to adjust their level of resistance to adapt to the increased oxygen demand required by the myocardium during certain times (such as during physical exertion). Ischemic heart disease is typically caused by atherosclerosis, which is a buildup of plaque inside the lumen of the coronary vessels. The emergence of atherosclerosis in the vessels does not occur overnight. Antman, et al. (2012) found that atherogenesis in humans typically occurs over a period of many years, usually many decades and that growth of atherosclerotic plaques probably does not occur in a smooth, linear fashion but discontinuously, with periods of relative quiescence punctuated by periods of rapid evolution. The process of atherosclerosis begins with an abundance of lipoproteins in the blood stream. These lipoproteins bind to the walls of vessels and are eventually deposited within the intima of the arteries. To counteract this process, phagocytes are sent into the vessel to attack these foreign particles (Antman et al., 2012). Once the phagocytes are within the intima, they mature into macrophages and become lipid-laden foam cells (Antman et al., 2012). As these plaques advance calcification occurs. This process is thought to be a key step in the formation of atherosclerotic plaques (Antman et al., 2012). Normally this narrowing of the vessel lumen does not cause chest pain or discomfort. Eventually, however, these plaques may rupture. At this point platelet activation occurs, which eventually leads to clot formation at the sight of the plaque. This clot, or thrombus, may break off and lodge in a coronary vessel. These two processes are a common pathogenic finding with acute coronary syndrome (Lincoff, Califf, Anderson, Weisman, Aguirre, Kleiman, Harrington Topol, 1997). A partial occlusion of the coronary vessels due to a ruptured plaque/platelet complex causes unstable angina or a NSTEMI. In this case, the oxygen demands of the heart cannot be met. A complete occlusion causes a STEMI (Anderson, Adams, Antman, Bridges, Califf, Casey Jr, Chavey II Wright, 2011), which eventually leads to myocardial cell death. Discussion/Analysis The emergency department providers are often the first line of defense in the management of patients with chest pain. The ability to quickly evaluate whether or not the cause of chest pain is potentially fatal is of great importance. Critical chest pain can be broken down in to non-cardiac and cardiac causes. Non-cardiac causes include: pneumothorax, pulmonary embolism, and Boerhaaves syndrome. Acute coronary syndrome is among several cardiac causes of emergent chest pain. An accurate diagnosis of the cause of chest pain requires several key components. These include: patient history (including risk factors), physical examination, diagnostics, and labs. History History is instrumental during the evaluation of a patient with chest pain. Ischemic chest pain is often described as a severe pressure or squeezing and is classically described as the feeling of an elephant sitting on my chest. Typically this pain is described as substernal chest pain which radiates to the neck, jaw, or down the left arm. Additional details regarding the onset of chest pain can also serve as important clues. For example, pain on exertion that resolves with rest suggests stable angina, whereas new onset chest pain or chest pain at rest suggests unstable angina. A good method to differentiate cardiac from non-cardiac chest pain is whether the pain improves after administration of nitroglycerin (NTG). If the pain is relieved by NTG it is considered to be likely due to cardiac causes. Additional details suggesting cardiac origin are shortness of breath, nausea +/- vomiting, diaphoresis, and the presence of syncopal/near-syncopal episodes. It is important to note that a patient with chest pain often have a silent or atypical presentation. This is especially true in elderly men (Woon Lim, 2003) and diabetics (Tabibiazar Edelman, 2003). A patient with an atypical presentation may present with shortness of breath but lack the classical symptom of angina pectoris which radiates to the jaw or left arm. Commonly these patients complain of a feeling of indigestion or epigastric discomfort. Thus it is very important to consider ACS in these patients. The presence of risk factors plays an important role in the evaluation of chest pain, especially in a patient with known disease. The landmark Framingham Heart Study showed that cardiac risk can be influenced by diet, lifestyle, and familial risk factors (Oppenheimer, 2005). The more risk factors that a person carries, the greater their risk of developing ischemic heart disease. These risk factors are generally grouped into two categories: those that are modifiable and those that are not. Risk factors amendable are as follows: Tobacco smoke (American Heart Association, 2012) High blood cholesterol (AHA, 2012) High blood pressure (AHA, 2012) Physical inactivity (AHA, 2012) Obesity and overweight (AHA, 2012) Diabetes mellitus (AHA, 2012) Risk factors that cannot be changed include: Age- 82% of people who die of coronary heart disease are >65 (AHA, 2012) Male sex (AHA, 2012) Heredity- this includes both family history and race (AHA, 2012) Risk is higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans (AHA, 2012) Patients presenting with unstable angina or NSTEMI have variable levels of risk of cardiac death and ischemic cardiac events (Antman, Cohen, Bernink, McCabe, Horacek, Papuchis, Mautner Braunwald, 2000). The trial conducted by Antman et al. (2000) set out to develop a simple risk score that has broad applicability, is easily calculated at patient presentation, does not require a computer, and identifies patients with different responses to treatments for UA/NSTEMI. In doing so, the TIMI risk score was created. The scores are calculated using a score of 1 for each risk factor (7 total categories) assigned to a given patient. According to Antman, et al (2000) the score determines the patients risk of death, myocardial infarction, or severe ischemia. Antman, et al. (2000) found 7 prognostic variables that increase a patients risk. These are: Age 65 years or older At least 3 risk factors for coronary artery disease (male, dyslipidemia, smoking, hypertension, diabetes mellitus, obesity family history) Prior coronary stenosis of 50% or more ST-segment deviation on ECG at presentation At least 2 anginal events in prior 24 hours Use of aspirin in prior 7 days Elevated serum cardiac markers In TIMI 11B/ESSENCE, event rates increase significantly as the TIMI-score increases (Antman et al., 2000). A score of 0/1 showed a 4.7% event rate; 8.3% for 2; 13.2% for 3; 19.9% for 4; 26.2% for 5; and 40.9% for 6/7. This landmark pair of trials allows practitioners a quick assessment of a patients risk of suffering a serious cardiac event. Physical Exam Physical exam is also a key component in the evaluation of a patient with chest pain, as many clues can suggest acute coronary syndrome. Unstable vital signs can be an important hint that the patient has suffered an MI. A general examination may reveal a patient who is diaphoretic and/or using accessory respiratory muscles. The cardiovascular exam could reveal a new murmur, S3/S4 gallop, or JVD. Finally, during the pulmonary exam rales may be heard upon auscultation. Diagnostics Diagnostic testing is an essential part of the evaluation of a patient presenting with chest pain. Several important diagnostic tools were introduced to the emergency department in the latter half of the 20th century that greatly improved the diagnosis and care of acute coronary syndrome. Electrocardiogram The introduction of coronary care units in the 1960s allows physicians to utilize the electrocardiogram (ECG) to monitor potential fatal arrhythmias in patients with acute myocardial infarction (Julian, 1987). Shortly thereafter the portable electrocardiogram became commonplace within the emergency department to assist in diagnosing complications of acute coronary syndrome (Drew, et al, 2004). A patient presenting with myocardial ischemia will typically have symmetrically-inverted T waves in leads V2-V6 (Dubin, 2000). As the name suggests, a STEMI is an ST-segment elevation myocardial infarction, though ST-segment elevation can occur with Prinzmetals angina in absence of an infarction (Dubin, 2000). Additionally, the ECG allows us to evaluate necrosis of the heart in the form of the presence of Q-waves. Q-waves are the first downward deflection of the QRS complex (Dubin, 2000). As Dubin (2000) explains, a positive Q-wave MI must: Lack a preceding spike in the QRS complex Be at least 1 mm wide or Have an amplitude of 1/3 the QRS complex An additional benefit of the ECG is that it allows the practitioner to identify the location of an acute event. Each lead corresponds to a particular location of the heart. For example, leads II, III, and AvF are the inferior leads and reflect the inferior portion of the heart. Due to the relatively high specificity but low sensitivity of the 12 lead ECG in diagnosis of acute coronary syndrome, a group of researchers in Canada recently set out to enhance ischemia detection by conducted a trial which added a new criteria using a three vessel specific leads derived from the traditional 12 lead ECG (Horacek, Mirmoghisi, Warren, Wagner Wang, 2008). This trial showed a statistically significant improvement in the ability of the vessel specific lead protocol to detect ischemia (Horacek et al., 2008). Horacek et al. (2008) found the following sensitivity and specificity for conventional STEMI criteria versus that of the vessel specific leads (VSL): Vessel Sensitivity Specificity Left Anterior Descending 74% conventional, 91% VSL 97% conventional, 97% VSL Right Coronary Artery 60% conventional, 70% VSL 94% conventional, 94% VSL Left Circumflex Artery 36% conventional, 71% VSL 100% conventional, 100% VSL Totals Set 60% conventional, 76% VSL 96% conventional, 96% VSL Based on these results, Horacek et al. (2008) concluded that using vessel specific leads can identify acute ischemia better than existing STEMI criteria. While a STEMI criteria using vessel specific leads has yet to become a mainstay within the standard emergency room protocol, this study provides exciting new improvements in the detection and management of patients with ACS. Serum Biomarkers The use of biochemical markers to detect cardiac cell death significantly evolved in the 1980s and 1990s. Initially, nonspecific markers such as aspartate transaminase and total creatinine kinase were used to detect myocardial necrosis (Lewandrowski, Chen Januzzi, 2002). During the mid-1990s the more cardiac specific enzymes CK-MB became the gold standard for detection of myocardial injury (Lewandrowski et al., 2002). CK-MB, which commonly rises 4-9 hours after the onset of angina, was not without its shortcomings. CK-MB may be falsely elevated due to several different causes, including recent strenuous exercise or skeletal muscle damage, or renal failure (Vivekanandan Swaminathan, 2010). In the late 1990s a more predictable biomarker, troponin I, was introduced for more accurate detection of acute coronary syndrome (Heeschen, Goldmann, Moeller Hamm, 1998). According to Heeschen et al. (1998), Troponin I can be evaluated at the bedside in the emergency room and has a higher diagno stic sensitivity for the detection of acute myocardial infarction (60% vs 48%) when compared to CK-MB. The reason for this improvement in accuracy is that troponin I is not found in skeletal muscle tissue or renal failure (Heeschen et al., 1998). As Heeschen et al. (1998) demonstrated in a head to head study that cTnI test systems produced no positive results in patients with end-stage renal failure and acute or chronic skeletal muscle injury, whereas 30% and 71% of the patients, respectively, had increased CK-MB mass concentrations. One disadvantage of troponin I, however, is that it has a lower sensitivity for the detection of acute myocardial infarction compared to that of CK-MB (Heeschen et al., 1998). This is due to an increased level of cTnI in patients with unstable angina (Heeschen et al., 1998). For this reason, a typical workup for a patient with chest pain in the emergency room includes both cTnI and CK-MB assays, which are drawn at presentation and every 3-6 hours therea fter (Ross, Bever, Uddin Hockman, 2000). Imaging A common component of a chest pain protocol is a chest x-ray. This is normally either a standard AP/lateral series or a portable chest x-ray if the patient is unable to get out of bed. The chest x-ray is useful to eliminate other possible causes of chest pain, such as an aortic aneurism or a pneumothorax. Contrast-enhanced computed tomographic angiography, or CTA, has become an integral part of the management of acute coronary syndrome due to its high sensitivity and specificity (Hoffman, Truong, Schoenfeld, Chou, Woodard, Nagurney, Pope Udelson, 2012). According to the ROMICAT-I study performed by Hoffman et al., (2012), CTA is an effective way to rule out myocardial infarction or ischemia as well as major cardiovascular events over the next 2 years from presentation. The data presented in ROMICAT-I showed that patients undergoing CTA decreased their hospital stay by 7.6 hours compared to standard therapy (Hoffman et al., 2012). Additionally, 50% of CTA patients were discharged from the hospital within 8.6 hours of presentation versus only 10% of patients undergoing standard therapy (Hoffman et al., 2012). Finally, the mean time to diagnosis was significantly decreased with the CT group versus the standard group (Hoffman et al., 2012). Overall, CTA was shown to reduce time spent in the hospital and time to diagnosis when compared to standard therapy for acute coronary syndrome. This is important to note considering the importance of quick coronary reperfusion of STEMI patients (Trost Lange, 2011). An additional observation was that these benefits were achieved without an increase in the cost of care (Hoffman et al., 2012). There was no overall difference between the groups in incidence of myocardial infarction 30 days after initial presentation (Hoffman et al., 2012). It is important to note that a patient undergoing a CTA is exposed to increased radiation. Additionally, patients undergoing CTA were more likely to undergo invasive coronary procedures when compared to standard evaluation. Based on this data, a question arises as to whether every patient presenting with possible acute coronary syndrome should undergo a CTA. The population studied in ROMICAT-I consisted of low to intermediate risk patients. Overall, CTA was shown to decrease the time to diagnosis and hospital stay for patients with possible ACS. In contrast, CTA increases a patients exposure to radiation and increases the likelihood that these patients will undergo an increase in invasive coronary procedures. These factors should all be considered when evaluating a patient presenting with chest pain. Treatment Pharmacologic Aspirin: Early aggressive aspirin (ASA) therapy (162-325mg followed by 81-162mg daily) is currently recommended for all patients with acute coronary syndrome, unless contraindicated (Kirk, Kontos Diercks, 2011). Plavix (Clopidogrel): According to the CURE trial Clopidogrel has been shown to provide a 20% reduction in cardiovascular death, MI, or stroke for NSTEMI patients with positive biomarkers or ischemic ECG changes (Kirk et al., 2011). It is important to note that the significant anti-platelet benefits of Clopidogrel administration should also be weighed against the increased risk of bleeding events if the patient may be a candidate for coronary artery bypass surgery. Antianginal Agents: Nitroglycerin (NTG): NTG is commonly administered by EMS respondents but can also be ordered once the patient arrives in the emergency department, typically sublingually or in the form of Nitropaste. Nitroglycerin dilates the coronary arteries, which reduces myocardial oxygen demand (Trost Lange, 2011). For this reason, it is important to evaluate the patients baseline blood pressure. If SBP is less than 100, caution should be used. Morphine: Intravenous morphine may be given in the event that chest pain is not relieved by NTG administration. Morphine reduces ventricular preload, thereby decreasing myocardial O2 demand (Trost Lange, 2011). Beta-Andrenergic Blockers: Beta-blockers decrease demand on the heart by decreasing heart rate, blood pressure, and myocardial contractility (Trost Lange, 2011). In a patient presenting with ACS, IV Lopressor is typically the agent of choice. These are especially effective agents in patients with elevated blood pressure or tachycardia. It is important to evaluate relevant contraindications to beta-blocker therapy, such as: HR Calcium-Channel Blockers: Diltiazem and Verapamil improve cardiac O2 supply by vasodilation of the coronary vessels, reduce O2 demand by reducing afterload, and reduce heart rate and contractility (Trost Lange, 2011). Calcium-channel blockers are 2nd line treatments for ACS and are typically reserved for patients who are unable to take a beta-blocker (Trost Lange, 2011). Contraindications include: sick sinus syndrome, 2Â ° or 3Â ° AV heart block, hypotension, acute MI with pulmonary congestion, atrial fibrillation or flutter with accessory bypass tract, and ventricular tachycardia, severe left ventricular dysfunction, and cardiogenic shock (Epocrates, 2012). Antithrombotic therapy: Antithrombotic therapy is recommended in a patient with suspected ACS, unless contraindicated (Trost Lange, 2011). Unfractionated heparin is easy to administer (IV) and is rapidly reversible with protamine in the event of bleeding. (Trost Lange, 2011). As with any antithrombotic, there is a risk of bleeding so these patients require close monitoring. Low molecular weight heparin is more predictable, has a lower incidence of thrombocytopenia, and does not require monitoring (Trost Lange, 2011). LMWH is the preferred agent for a more conservative, ischemia-guided strategy to prevent in hospital death or myocardial infarction (Trost Lange, 2011). Bivalirudin is an antithrombotic agent that does not cause thrombocytopenia (Trost Lange, 2011). It has been shown to be equally as effective as unfractionated heparin or LMWH but with a significantly lower rate of bleeding (Trost Lange, 2011). Oxygen administration should be administered for patients who are short of breath, showing signs of shock, or O2 saturation Next Step for NSTEMI or Unstable Angina Patients If a patient is considered to be high risk, such as a patient is at risk of future ischemia or infarction, an early invasive strategy is recommended (Trost Lange, 2011). For these patients, cardiac catheterization should be performed within 24-48 hours of admission (Trost Lange, 2011). In a low risk patient, a more conservative treatment is typically recommended. For these patients, catheterization is only recommended if recurrent or provocable ischemia occurs (Trost Lange, 2011). TIMI scores are a valuable tool to assess the patients risk and to guide the practitioner on the appropriate next step. Next Step for STEMI Patients Prompt coronary reperfusion is paramount in patients presenting with STEMI (Trost Lange, 2011). A door-to-balloon time of less than 90 minutes is considered to be the goal (Trost Lange, 2011). If the patient presents to a facility without a percutaneous coronary intervention facility the patient should be either: Treated with fibrinolytic therapy if not contraindicated (Trost Lange, 2011) Or Transferred to a nearby PCI facility (Trost Lange, 2011). Conclusion Acute coronary syndrome is spectrum of diseases typically caused by atherosclerotic disease. Emergency department practitioners must be able to rapidly diagnose and manage ACS patients in order to potentially preserve precious heart muscle. While treatments for ACS have improved dramatically over the past 30 years, several recent innovations have brought upon exciting new possibilities for the care of these patients. These include new vessel specific ECG leads, cardiac specific biomarkers, and the use of computed-tomographic angiography to assess patients with possible ACS. One component of the management algorithm that has not changed is the need for a strong history and physical examination to aid in diagnosis. Urgency in obtaining diagnosis cannot be stressed enough, and patients presenting with STEMI should be rapidly sent for PCI or transferred to a facility with PCI capabilities.

How Infidelity Affects the Marriage and Family? Essay

A liaison, sexual or in any aspect, outside of a marital relationship is an immoral effort and excuse to improve something. Others may say that not all people, who are having or had an extra-marital affair, are regarded as bad and despiteful. These people are generally and oftentimes are in pain, bewildered and lonesome. However, for those who were betrayed, these reasons do not justify nor make one’s infidelity acceptable. One’s involvement to other than his or her partner has a lasting painful and devastating effect not only on the marriage of a couple but more on their children. Fidelity among the parents is the most treasured component of a marriage. It can be regarded as a strong foundation of the entire family. When infidelity sets in, the strong union of the couple is shattered, leaving traces of dishonesty, guilt, and anger. Aside from the betrayed spouse, the children who are not involved in the problem between the couple that caused the break-up are the ones who suffer from the effects more. Infidelity is caused by complicated and different reasons. Extra-marital affairs can happen in both happy and disturbed marriages. Regardless of the cause, what the family evidently needs to be overcome is the manners in which infidelity severely affects the couple’s marriage and the family in general. Characteristics of Infidelity According to Marriage and Family Encyclopedia, infidelity is characterized by a â€Å"breach of trust† which is a reflection of one’s adulterous and cheating of ethical and emotional responsibilities to his or her spouse. Infidelity normally and oftentimes connotes a person’s intimate or sexual relationship to another individual other than his or her partner (Treas). Aside from an immoral sexual relationship, infidelity also comes in other forms. For instance, despite the lack of physical contact, women generally consider a deep emotional liaison as another form of a treacherous extramarital relation (Treas). These characteristics present infidelity as any emotion or conduct that go against or not in accordance with what one expects from his or her spouse and what makes the relationship exclusive (Treas). Infidelity is a worldwide issue, with some countries going beyond their boundaries to address its causes and effects. Aside from the ways in which infidelity affects the marriage and the family, its related topic such as an open marriage that is practiced in liberal countries also has an impact to the overall understanding of such unfaithful relationship. The books of Blumstein and Schwartz, as well as that of Greeley, states that the practice of open marriage in the United States which allows and opens an opportunity for a married person to commit extramarital sex is the only exclusion. Although the two books report that some Americans apparently tolerate open marriage, majority of American couples still regard sexual fidelity as an ultimately significant aspect of their marriage and the one which hold their family together (Blumstein & Schwartz; Greeley). This high consideration to fidelity is supported by an article which states that almost one hundred percent of American couples look for â€Å"sexual exclusivity† from their partners (Treas & Giesen 48). The Effects of Discovered Infidelity An article written by Shirley Glass which appeared on the American Association for Marriage and Family Therapy site states that it is usual for the couple, either the one who committed infidelity or the one who was betrayed, to be depressed. Glass further stated that such feeling of demoralization includes suicide tendencies and anxiety. She added that an intense perception of loss follows the discovery of infidelity. According to Glass, the responses of the cheated partner correspond to the indications of â€Å"post-traumatic stress† experienced by the victims of harmful or even fatal situations. At the onset of the disclosure of the unfaithful relationship, the usual effects are â€Å"loss of innocence and shattered assumptions. † Included in such premises are the obsessive contemplation of the details of the infidelity, nonstop observation of other aggravating symptoms of cheating, recurring and invasive images of the betrayal, and an increased biological arousal due to a sexual effort to win back the partner (Glass). Those who have exerted much trust and the least suspecting are the most badly affected and hurt. The philandering partner, on the other hand, is worried that his or her infidelity will result in a lasting punishment and further suffering. This is because the dreams he or she associated with the extramarital relationship were wasted (Glass). Ways in Which Infidelity Affects The Marriage Infidelity affects not only the marriage but the divorce proceedings that happen afterwards (Treas). Prior to the passing of â€Å"no-fault divorce laws in the 1970s,† a cheating spouse is expected not to be granted with custody rights over his or her children, endure disadvantages in the separation of conjugal properties as well as in payments of support (Treas). In eliminating adultery as grounds for divorce, the â€Å"no-fault laws† likewise remove extra-marital sex as a vindication for preferring one’s welfare over the other partner (Treas). Aside from affecting the marriage, infidelity or other related laws in the United States would forbid a philandering spouse from casting a vote, engaging in alcohol-related works, exercising law, legally adopting a child and living with the previous partner (Treas). It was unfortunate that adultery laws are almost never implemented, despite the fact that a lot of states have silently revoked such outdated legislative acts (Treas). Unrepealed laws then only function mostly for symbolic intentions, representing the state’s adherence for traditional ethical and family living (Treas). Laumann, and his colleagues, on the other hand, stated that the issue of how sexual infidelity impacts the marriage necessitates further research. However, experts on marriage counseling have attested that sexual infidelity definitely rocks a couple’s marriage (Laumann, et al. ). In their book, Laumann and his associates also identified another manner, aside from divorce, in which infidelity affects the marriage. This is the existence of domestic violence which was also already identified as an effect of sexual enviousness (Laumann, et al. ). Lawson corroborated the above destabilizing theory or effect of infidelity to marriage. According to Lawson, infidelity contradicts the couple’s intimacy, weakens the perceptions of shared â€Å"ownership† between a husband and wife, and cuts short commonality that exists when one’s spouse is the only one giving a treasured intimate or â€Å"sexual service. † Sexual infidelity also deviates â€Å"time, energy, and money† outside of the marital union. This is evident when a betraying partner allots or spends more of his or her quality time, physical energy, and cash with a person other than the legal partner. Lawson also said that women’s extramarital relationships are likely inclined to result into divorce or new marriage. This is because of women’s nature of involving of too much emotion into a relationship (Lawson). Ways in Which Infidelity Affects The Children Aside from the emotional and psychological trauma, the infidelity of the parents creates confusion among children, similar to the effects experienced by the betrayed parent that the children feel. An online article by Dianna J. Gould-Saltman stated that in the event the extramarital relationship eventually resulted into the separation of a couple, it becomes an issue if the presence of the new partner will be considered in limiting custody or visitation right over the children. Confusion among the children is evident when the new partner of their father or mother starts to live in the house and the new couple can eventually and freely exercise their sexual activities even when the children are around. This scenario causes children to ask if sex outside of marriage is alright. However, it was stressed that the law states that â€Å"the court must make custody orders consistent with the best interests of the children. † The said article added that unless there is opposing evidence, it is expected that the children of the separated couple still require constant contact with both the father and the mother regardless of whoever committed the infidelity (Gould-Saltman). Infidelity Affects Both the Marriage of the Couple and their Children The same Gould-Saltman article identified three combined issues resulting from infidelity that affect both the marriage of the couple and their children. First is misappropriation which is manifested when the philandering partner takes away or deviates the money supposedly intended for the needs of his or her family. A married person is obligated to manage his or her marital assets, such as the monthly employment income, for the purpose of addressing the needs and promoting the welfare of his or her family. Gould-Saltman said that â€Å"spending community money on a girlfriend or boyfriend, especially expensive gifts, paying for rent or mortgage, or vacations can be deemed a misappropriation. † In view of this the betrayed spouse and the children are authorized to refund â€Å"one half of the funds spent, possibly with interest, from the date of the misappropriation† (Gould-Saltman). Misappropriation, however, is different to another effect which is â€Å"supported spouse. † In the latter, the spouse who was left behind in favor of a new partner will be burdened with proof in getting support from his or her spouse. This takes place when the spouse already â€Å"cohabits† with his or her new partner who now receives the financial support. In doing so, the child support may also somehow be affected because the income is now shared with the new partner. However, this situation can be resolved through legal arrangements. The last effect, which is the possibility of acquiring sexually transmitted disease, is solely experienced by the betrayed spouse. With this impact, the offended spouse, who was transmitted with the disease resulting from the philandering of his or her spouse, is considered a battered spouse and entitled for monetary damages (Gould-Saltman). Conclusion Infidelity is a sensitive issue which does not only affect the legal union of a couple but also leaves the entire family devastated. It is perceived as a one-sided option wherein only the betraying spouse benefits while the offended spouse and their children suffer. The ways in which infidelity affects the spouse and the children cause them to endure suffering in terms of emotional, psychological, and financial aspects which are unfairly happening to them. Such unfaithful conduct unjustly favors the philandering spouse and steps on the rights and protecting the feelings of the betrayed spouse and children. This is because while the philandering spouse is enjoying his or her sexual trysts with the new partner, a husband or wife and the children are left tormented with the pains of infidelity. Works Cited Blumstein, Philip and Pepper Schwartz. American Couples: Money, Work, Sex. New York: Morrow, 1983. Glass, Shirley P. â€Å"AAMFT Consumer Update: Infidelity. † American Association for Marriage and Family Therapy. 2002. 14 April 2008 . Greeley, Andrew M. Faithful Attraction: Discovering Intimacy, Love, and Fidelity in American Marriage. New York: TOR Books, 1991. Gould-Saltman, Diana J. Adultery: Does It Make Any Difference? Divorce Wizards. 1998. 14 April 2008 . Treas, Judith. â€Å"Infidelity-What Are The Consequences? † Marriage and Family Encyclopedia. 14 April 2008 . Laumann, Edward. O, et al. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, 1994. Lawson, Annette. Adultery: The Analysis of Love and Betrayal. New York: Basic Books, 1988. Treas, Judith and Deirdre Giesen. â€Å"Sexual Infidelity Among Married and Cohabiting Americans. † Journal of Marriage and the Family 62 (2000):48–60.