McClellan Genealogy Essay Example

McClellan Genealogy Essay Name: Course: Lecturer: Date: We will write a custom essay sample on McClellan Genealogy specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on McClellan Genealogy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on McClellan Genealogy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer McClellan Genealogy The McClellan genealogy is among the earliest recorded family trees, dating back to the 14th century. Its name was a combination of Scottish names, Gaelic Mac Gille Fhaolain and Irish names, Mac Giolla Fhaolain. The name represented the surname of the family. The family was quite extensive in numbers across the Galloway area during the 14th century. As was the tradition for most families, McClellan family had a coat of arms or family crest with its meaning and significance. At first, the coat of arms was meant for identification during battles and tournaments. At the time, reading was hard for most people. Considering that the men were armored from head to toe, the need for identification arose in order to identify each other on battlefields. Therefore, coat of arms was inscribed on the helmets and their shields colored the same for identification. This was necessary since they covered their heads as well, making it hard to notice who was the enemy. Soon, the crests were used for fa mily purposes for identification including surnames. Thus, this heredity of the surname and the coat of arms came into existence with an aim of identifying a family in a unique way (4crests.com n.d). In a similar manner, the McClellan had its crest that identified them as well as described their attributes. The coat of arms has additional meaning and significance. The color of the coat of arms on the shield signifies generosity, implying that the family was munificent. The two arrow shaped lines looking upwards symbolized the roof of a house that, according to the family, signifies protection and faithful service (irishsurnames.com 2009). The hand at the top of the court of arms represents a person fit for high and mighty deeds, which signifies the ability of the McClellan family. The helmet on top of the shield signifies wisdom in defense. Leaves surrounding the court of arms signify strength and antiquity. Work cited Irishsurnames.com. Heraldic Charges. irishsurnames.com, 2009. Web. January 11, 2013. 4crests.com. Coat of Arms Family Crests Store: McClellan Coat of Arms / McClellan Family Crest. 4crests.com, n.d. Web. January 11, 2013.

Charles Babbage essays

Charles Babbage essays Charles Babbage is often called the "father of computing" because of his invention of the Analytical Engine. However, many people do not know the details of this very important mans life. Charles Babbage was born on December 26, 1792, just about that same time that the industrial revolution was beginning. He was born in Teignmouth, Devon shire. Although not much is really known about his childhood, it is known that he had many brothers and sisters, but many of them died before adulthood. It is also known that Babbage never really played with his toys, instead, he would dissect them. When Babbage grew up he attended many new schools. He ended up at Forty Hill, where he was famous for mischief but for some reason or another Babbage still studied. He did bad things like carved his name in his desks, violated his curfew, and insult the minister's sermons. He still found time to wake up with a friend at three in the morning and study in the library until five-thirty. Frederick Marryat, Babbages roommate and a future novelist, joined his morning study group. When Marryat began to attend regularly he started to bring more and more friends. And the once study group now became wild parties that were eventually broken up by the schools head master. After both Marryat and Babbage had become famous they loved to tell how they were deemed the two students most likely never to amount to anything. Babbage created his first invention, a type of shoes make of books that helped one walk on water, at his fathers summer home. This idea was good, but it didnt work, because he would weave too much from side to side and eventually fall over. It is told that in 1810, at the age of nineteen, Babbage went up to Trinity College, Cambridge with some friends. Babbage studied grammar, literature, and many other important lessons, but he found his obsession to be mathematics. He read many books on the subject. Bab...

Barriers Impeding Technology Integration in Education Dissertation - 1

Barriers Impeding Technology Integration in Education - Dissertation Example The research question that directed the whole research is What are the barriers hindering teachers in adopting technological integration in their classroom pedagogy? From this issue, several sub-questions have been posed to clarify the various concepts embedded in the research. These questions are 1. What is technological integration? What are the stages of technological integration? 2. What are the effects of technological integration to students learning process? 3. What are some of the current best practices used for the integration of technology in classroom pedagogy? 4. How does the issue of funding affect the integration of technology in classroom pedagogy? To answer these questions, both primary data and secondary data have been generated and collected. For the collection of primary data, a qualitative research using in-depth interview of nine participants and group discussion/sharing with four participants have been conducted. The collected data collected data have been exami ned, coded, evaluated, assessed and analyzed several times to find themes, patterns and relationships in each case and across other cases. Moreover, to ensure the validity, reliability and integrity of all the data the following strategies have been used. These are the ethical consideration in securing the consent of the participants have been rigorously observed. Triangulation, member checking, thick rich description, and management of the researcher’s personal bias have been adopted. For the collection of secondary data, which includes scholarly journals, notes from the interviews and reflection, a library research had been performed. Meanwhile, for the notes and reflection, a journal had been maintained in the course of the research. The themes that have emerged in the study are teaching ethos, benefits of technology in education, approaches to integration of technology in classroom pedagogy, concept of barrier clarified, and identified existing barriers to integration of technology in classroom pedagogy. Some of the findings of the research includes: a table and list of identified existing barriers, the categorization of existing barriers, the study offers conceptual clarifications of ideas embedded in the issue and finally it proffers the supposition that there is no one penultimate reason for the problem, but that the issue is a result of the combination of various factors. Section 4 Findings In response to the challenges and demands of the contemporary period to education, the research has looked into one of the most challenging and invigorating demands of the time – the integration of technology in classroom pedagogy. Challenging, because, the necessity for the integration of technology in classroom pedagogy is a response to the current human condition. Likewise, it is a reflection of the initiative to improve the educational institution towards academic excellence and a drive towards enabling children in becoming responsible global citiz ens. In this regard, integration of technology in classroom pedagogy is invigorating for it requires innovation, creativeness and a new approach in classroom pedagogy. In the face of these challenges and changes in education and technology, both scholars and the teachers agree that technology in edu

Broadcast news story Essay Example | Topics and Well Written Essays - 250 words

Broadcast news story - Essay Example Fox Sports 1 appears to have accepted the challenge and it aims to set new standards of sports telecast by introducing the newly emerging idea of â€Å"Jockularity† as part of their regular telecasts. The new channel aims to establish its reputation as a funny, irreverent and so called ‘less-serious’ sport channel. They say that they will engage the services of some really famous Canadian pranksters to anchor the network’s flagship programs. Regis Philbin is also expected to host a show at the new sports network. â€Å"What we are fighting is inertia. ESPN has a 30-year head start, and they are doing a remarkable job. We are very much the underdog, and we have to convince the sports-viewing public that what we have on offer is better—or as good as—what ESPN has been offering. We have to create a personality.† (Greenfeld) Greenfeld,  K.  T. (2013, July 18). Fox Sports 1s Strategy vs. ESPN: Jockularity - Businessweek. Retrieved  May  18, 2015, from

Saudi Arabia Essay Example | Topics and Well Written Essays - 1750 words

Saudi Arabia - Essay Example The most difficult duty that the King has to perform is to maintain a balanced and harmonious relationship among the Royal Family members, the upper-class people of the society and the Ulama, an Islamic religious community (Lacey 39). The difficulty mainly arises from the conflict of interests between the religious community and the other bourgeois class people, as in this regard, Matthes et al says that the king’s decision-making often involves maintaining balance and mitigating â€Å"conflict between religious and power interests† (3). Due to the tribal pattern of the Saudi Arabian society, the King often needs to interfere into tribal agreements, and at the same time, to renew the government’s agreements with the Arabian tribes. It is mutually agreed that, unlike a democratic political system the Saudi Royal Family is endowed with the power to dethrone the King. Overview of Saudi Arabian Government From the very beginning of the establishment of the Kingdom of Saudi Arabia in 1932, the country is being ruled under monarchy, as Gerald Butt, a middle East Analyst, says, â€Å"The history of Saudi Arabia is entwined - as much as its name is - with the fate and fortunes of the House of Saud, which traces its origins back to the 18th Century† (2). ... t, Matthes et al says, â€Å"Occupying nearly all the important state positions, the large Al Saud family dominates Saudi-Arabian politics as well as parts of the economy making the desert kingdom a â€Å"family firm†(4). The country’s high authoritative decisions come from a cabinet of 15 members. Since the cabinet primarily consists of members who are close in kinship to the King, it becomes often difficult to take a decision by fulfilling all of the members’ interests. The decisions are often deterred and protracted. Constitution of Saudi Arabia: Interests of Royal Family, Islam, and the Leading Technocrat in it Since Saudi Arabia’s constitution consists of the Koran, Allah’s laws and Sunnah, the explanation of the Koran, the country does not have any constitution in traditional sense, rather it has some 83 operational laws on which the kingdom is expected to be operated. Since the state is responsible for the enforcement of Islamic law or Shari ah, the Saudi constitution does not consider the existence of religious organizations. Also Article 5 declares the political system of the country as monarchy and also it does not permit any political organizations in the country. According to article 5c, the King can choose his heir. Though the King is considered to be endowed with unfettered power, he is expected to respect Islamic Laws and Values. According to Article 44, three types of authorities are considered to function as parts of the state, while the King preserves the supreme power to interfere into any of these authoritative powers. According to the Saudi Constitution, the monarchy is considered as the key source of power with the right to interfere into any level of the government. The Council of Ministers and its Functions during the Years Prior to 1990

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.

Grendel Vs. Beowulf Essay -- Epic of Beowulf Essays

Grendel   Ã‚  Ã‚  Ã‚  Ã‚  One of the most compelling and highly developed characters in the novel Grendel, written by John Gardner, and the poem Beowulf, written by an anonymous poet, is the monster, Grendel. Even though these pieces show two different sides to Grendel they are similar in many ways. Grendel evokes sympathy toward the hideous monster by making him seem like the victim, while Beowulf portrays him as being the most loathsome of enemies. The reasons behind Grendel’s being, his killing, and finally his death make him one of the most controversial and infamous monsters in literature. Grendel is the man-killing monster that Beowulf portrayed him as being, yet he is also the lonely victim of a judgmental world. Grendel is a descendent of Cain and is forced to live with the inherited curse of being denied God’s presence. Cain’s lineage has been known to spawn monsters, trolls, giants, and other undesirable beings, all of which were rejected from society. Beowulf and Grendel both speak of Grendel’s ancestor Cain, almost as if using it as an excuse for his rash and murderous actions. Beowulf told of a Grendel that mercilessly attacked Hrothgar’s meadhall killing men without reason. Grendel also speaks of this evil monster, but in a more sympathetic and excusable manner. Grendel is thought of as “the guardian of sins'; and is the physical equivalent to a man that has been shunned by God. He is des...

The Art and Science of Creating a Monster

Albert Einstein, one of the greatest scientists in the world, believes that there is one question human beings must answer in order to truly understand the implications of existence itself: Is the Universe friendly?   In the vast body of thought both ancient and modern, the answers to this question are numerous and mostly contradictory.   In Mary Shelley’s Frankenstein, the narrators uniformly answer this question in the negative.   In spite of their disparate stations in life, each storyteller feels separated from his fellows in some way, physically, intellectually, and geographically.   Society does not ease the condition of such lost souls because it is so quick to ostracize and dismiss anyone that departs from its grand ideals of what is acceptable (Williams, 1).Most artists, scientists, philosophers, and explorers are not celebrated until several centuries after death, if then.   Human beings are extremely social creatures.   In order to function well, people need to feel as though they are a part of something bigger than themselves, that they share a similar path to those around them.   Though he was denied the decency of others, the creature had only one wish; to have a companion made for him.   If he never encountered another living being except for her, he would have been contented in the spirit that there was someone in existence that could relate to him.   Victor Frankenstein, brilliant scientist extraordinaire literally sold his soul for godhood.At the end of his story, he shares the same fate of his creature: friendless and alone with only strangers to ease his passage into death.   In a sense, one could conceivably argue that Victor suffered just as much as the creature because he had his whole world taken from him—his little brother, best friend and his wife.   In the end, he becomes as wretched as the creature without soul or companionship and perished among strangers.   For one who has known genuine happine ss, life’s tragic moments become even more painful.Robert Walton, the sailor that tells the story of Frankinstein and his creature is equally marginalized.   He is without friends because his aspirations were lofty and his education limited.  Ã‚   When one leaves the path of the establishment to explore new and sometimes frightening realms, or departs from the norms expected for one’s gender, race, or intellectual achievements:   society exacts punishment by banishing him to the fringes.The creature is the most obviously reviled being in the story.   On a dark and stormy November night, he awakes to Victor’s horrified screeches.   His physical appearance produces instant disgust in everyone he meets, including his â€Å"father† and creator.   During the Romantic Era and in Gothic literature, physiognomy was a way to determine a person’s character and inclinations (McLaren, 40).   Elizabeth was thought to be an angel because of her bea utiful golden hair and fair countenance, while people assumed the creature was morally degenerate because of his ugly appearance.The creature had the sallow skin of a dead thing, he was extremely tall, strong, and bright, yet he was very malformed.   In the eighteenth century, ugliness and deviance were heavily correlated.   In many of the stories of the time, the hero and heroine were extremely good looking, virtuous, and talented in some special way.   In contrast, the villain was ugly, amoral, violent, and without conscience.   Even if there were a great degree of credence to this, it would seem that the violence toward others is simply a villain’s expression of loathing both self and society.â€Å"This violent response to his own oppression shares the same elements of many of the post-WWII protest novels.   Protest novels often delineate a relationship between the mainstream dominant society and the â€Å"Other,† a character designated for his/her margin alization and oppression within that society†(Scott).   Before departing to the wastelands of the North to end his miserable existence, the monster gives an accounting to himself to Walton, even though he believes that it would not move the sailor to sympathize with his plight.Little does the creature know that his confessor had lived without a friend or companion.   Had things turned out differently, maybe Walton and the creature might have become friends because both were alone in the world.   The creature’s story is very reminiscent of the tragic poor, malformed vagabonds living on the fringes of society, exposed to only the worst traits and abuses of   other human beings.   As a living creature, the monster wanted to be shown decency, compassion, gentleness and even love and he was denied at every turn.   He hated himself and the world and turned his grief and rage into a force of darkness that would avenge itself on everything and everyone his creator h olds dear.â€Å"I desired love and fellowship, and I was still spurned. Was there no injustice in this? Am I thought to be only the criminal, when all humankind sinned against me?†(Shelley, 210).  Ã‚   While some literary critics believe that the monster represents the depravity that lies dormant in all human beings until pushed to the breaking point (Scott), others have determined that he is instead, a voice of social justice.   When external conditions become so unbearable that it takes every ounce of effort to simply survive, this experience justifies any act of rebellion against the social order (Knoepflmacher & Lewis, 165).  Ã‚   To the creature, Victor Frankenstein represented the malignancy and callous disregard for life he encountered in his life experience.   When his last chance for a companion was destroyed in his creator’s ultimate breach of trust, he made it his life’s mission to destroy everything his creator loved without assuming personal responsibility for his death.Victor Frankenstein, not content with pursuing a normal career in medicine, aspires to godhood.   Because of his hubris, he loses everything he holds dear in his life and dies alone in an arctic desert.   Unlike his unfortunate creation, he represents the very establishment from which his ambitions set him apart.   His childhood was normal in an idealized sort of way.   His parents lavished tons of attention on him and he never had a moment of feeling unloved, neglected, or spurned by other people.   Growing up in Geneva, his life was extremely sheltered, and the people in his life were good and beautiful.   His aversion to ugliness is one of his most pronounced character traits.When he enrolls in University, he immediately judges the character of his professors based on their physical appearances, â€Å"I found even in M. Krempe a great deal of sound and sense and real information, combined, it is true, with a repulsive physiognomy and man ners.  Ã‚  Ã‚   In M. Waldman I found a true friend.   His gentleness was never tinged by dogmatism and his instructions were given with an air of frankness and good nature that banished every idea pedantry†(Shelley, 49).This passage makes Frankenstein appear shocked that M. Krempe would have anything of value to offer him because of his unattractive appearance.   Another despicable character trait is Victor’s inability to take responsibility for his actions.   Once the creature wakes up, he rushes from the room (Shelley, 57).   Later, he allows an innocent woman—the family maid he grew up with no less—to be executed for a crime she never committed to hide the existence of his creature (Shelley, 84).Robert Walton, not content to explore the vast inhabited regions of earth, braves the cold and ice to look for a northern route to the Pacific Ocean.   He wants to â€Å"boldly go where no man had gone before† to paraphrase Star Trek.   How ever, all he found was an endless wasteland that did not deliver the passage he had sought.   Though he merely serves as the recipient of Frankenstein’s story, he has no one in the world except his sister.   In this sense, he identifies with the creature’s feelings of loneliness.   In his second letter he tells his sister, â€Å"But I have one want which I have never yet been able to satisfy, and the absence of the object of which I now feel as a most severe evil.I have no friend, Margaret: when I am glowing with the enthusiasm of success, there will be none to participate in my joy; if I am assailed by disappointment, no one will endeavour to sustain me in dejection†(Shelley, 18).   While he is normal physically, his educational background sets him apart from others.   He is self-taught, and his curriculum included books of voyages and fantastic adventures, and the poets he had become familiar with were British.   Later, he laments that he is  "more illiterate than many schoolboys of fifteen†(Shelley, 19).  Ã‚  Ã‚   Still, he could not help feeling a little pity for the creature’s ordeal since part of it resembled his own, â€Å"Once my fancy was soothed with dreams of virtue, of fame, and of enjoyment.Once I falsely hoped to meet with beings who, pardoning my outward form, would love me for the excellent qualities which I was capable of unfolding.   I was nourished with high thoughts of honor and devotion.   But now crime has degraded me beneath the meanest animal†(Shelley, 209).   In that last desperate section following Frankenstein’s death, we realize that had Frankenstein not treated his creature so ill, he could have become a reliable companion, loyal friend, and confidant†¦the very thing Walton had become to Frankenstein when he was cold, alone, and starving.   Even as two wealthy white European men, Walton and Frankenstein failed to flourish in a society that was uniquely designed for them.While the two men and the monster keenly felt their separation from others, the women are practically non-characters.   Even though a woman that inhabited the extremely liberal artistic scene of the Enlightenment Era wrote the story, all the female characters assumed no importance of their own in a truly strong and heroic sense outside of their impact on Victor’s life.   They were objects, not subjects.   Even the monster was able to express himself as a subject, while the women served as props. Still, there was much about them that would potentially interest a reader if the characters were explored in greater depth.   Frankenstein’s mother was a philanthropist who visited poor families and attempted to ease their lot in life.Elizabeth was very passionate in the defense of Justine when she was falsely accused of murder (Shelley, 81).   As an orphan raised by peasants and adopted into a wealthy family, her character’s death would have been much more dramatic and poignant had she been flushed out more.   While Shelley achieved much as a writer, she did not want to encourage women to become more assertive, and none of the female characters (other than Walton’s sister) survived until the end of the book.One account states that Shelley believes women must behave differently from men (Schoene-Harwood, 42).  Ã‚   During the Romantic Era, men were the heroes, the creators, the actors in public life and the centerpiece of home life.   Women were the passive observers, and sometimes creators of brilliant artistic works.   Otherwise, the rest of the world belonged to men.Times have certainly changed, but not as much as people think.   Global travel exposes people to different cultures, ideals, and mores.   In the field of social psychology, the most successful societies assimilate outsiders rather than marginalize them.   To maximize the likelihood of maintaining a peaceful civilization, the newcomers must adapt the mores, values, and language of the dominant culture and the institutions must be able to accommodate the tansition.   When a population is exiled to the fringes, it would possibly create a volatile situation of accelerating tensions between the marginalized group and the dominant group to the point where the people on the fringe begin to attack the establishment in ways both subtle and explosive (Simon, 141-146).In American history, immigrants were looked down upon and many laws were passed to keep them out.   Eventually, groups of immigrants had begun forming their own communities, keeping the spirit of their home culture alive in a country that neither wanted nor welcomed them.   With the growth of these communities, people no longer have the need nor desire to learn the dominant language.   On a whole, people in the West are gradually becoming more tolerant toward alternative lifestyles, minority groups, and religious preferences, but the bias and prejudice against people not gifted with physical beauty is the final socially acceptable prejudice to hold. Women in the Western World had finally been granted the right to vote; even so, a woman’s value is still vested in her looks and ability to become a wife and mother.Until a woman’s choice to attain worldly power is respected, they will never achieve the same level of equality that men assume.   Shelley’s women were faithful in their duties of domestics, artists, and lovers, but like many women of the time; were not allowed to express the hidden passion they were forced to repress.   Even in our own society, marginalizing others is still par for the course.   In the US, a strict racial hierarchy is still perpetuated even though the apartheid was legally dissolved in the 1960’s.   There is a great disparity between the races when looking at factors such as life expectancy, disease profiles, and income.Progress toward a better world is often slow and a lways painful.   In order to maintain social stability, people did not evolve the ability to accept sweeping changes on all levels.   Appearance in the twenty-first century will become an even greater obsession than it was in the past.   With superior technology to alter, enlarge, or diminish undesirable characteristics, beauty will quickly become associated with social class and personal value.   When Elizabeth was adopted, Frankenstein’s mother believed that she was a higher order of being by virtue of her physical appearance, â€Å"a being heaven-sent, and bearing a celestial stamp in all her features† (Shelley, 34).Victor Frankenstein’s monster was a different order of being himself, he was purely logical, empathetic, and selfless, but he was hideously ugly.   Eventually, through repeated rejection, brutal treatment, and several attempts on his life, he was trained to mold his character to match his looks.   To those living on the fringes, the un iverse is an extremely unfriendly place indeed.Works CitedCaldwell, Janis McLaren. Literature and Medicine in Nineteenth-Century Britain: From Mary Shelley to George Elliot. Cambridge University Press, 2004Knoepflmacher, Ulrich Camillus & George Lewis. The Endurance of Frankenstein.   University of California Press: 1979Schoene-Harwood, Berthold. Frankenstein: Essays, Articles, Reviews. Columbia University Press: 2000Scott, Cynthia C. â€Å"The Other: Race, Rage, Violence and the Protest Novel in M. Shelley's Frankenstein†. The People’s Media Company. 3 Mar. 2007 ;http://www.associatedcontent.com/article/28245/the_other_race_rage_violence_and_the.html;Shelley, Mary. Frankenstein. New York: Signet Classic, 1965Simon, Bernd. Identity in Modern Society: A Social Psychological Perspective.   Boston: Blackwell Publishing, 2004Williams, Kipling D. The Social Outcast: Ostracism, Social Exclusion, Rejection, ; Bullying. New York: Psychology Press, 2005

Why is there a Price Tag on My Back Professor Ramos Blog

Why is there a Price Tag on My Back I had just gotten off of my closing shift at work and headed to the local Wal-Mart to pick up some cereal to satisfy my late-night cravings. I was driving a 2007 Ford Focus that continuously was always dying on me, partially because I hadn’t yet mastered how to drive a manual transmission. As I arrived at Wal-Mart, I chose to park underneath one of the lights about halfway through the parking lot and picked up my phone to call my mom to see if she needed me to pick up anything for her. While the phone was ringing, I noticed a white van, rusting along the corners with the windows blacked out and the sliding door or the right pull up directly in the parking spot to the left of me and four middle aged Hispanic men got out. I knew that something wasn’t right, and uneasiness engulfed my entire mind and body. As they surrounded my car, my mom answered the phone. My heart pounded and my adrenaline began to rush through my veins like lightning. They surrounded my car when who a ppeared to be the oldest began to speak to me. â€Å"Hey beautiful, you got a lighter?†. At this same time, he reached for my door. I quickly pushed the clutch down, shifted my car into reverse and prayed that my car didn’t die on me. My mom answered the phone at the same time and said, â€Å"hey honey, what’s up?† and I stumbled for my words. â€Å"Mom, I almost got kidnapped†. Human trafficking is the fastest growing crime in the United States and is one of the most popular reasons why somebody can go missing. Millions of people go missing year and hundreds every day. We are presented with an immense problem that devalues each and every single last drop of our own self-worth and many of us are completely unaware that the problem even exists. I myself was only placed in this situation for a couple minutes, but this is a memory that is and forever will be engrained within my memory until the day that I die. How would you like to be forced to do whatever somebody tells you to, never being able to tell somebody no and not having the right to think- or much less act for yourself? The Oxford dictionary defines human trafficking as â€Å"the action or practice of illegally transporting people from one country or area to another, typically for the purposes of forced labor or sexual exploitation.† According to the International Labor organization, forced labor creates an annual amount of $150 Billion in a year through illegal profits. Those who are forced into labor suffer extreme and inhumane work conditions, most frequently in agriculture, mining or manufacturing jobs. Victims are threatened if they show any disagreement with the traffickers and can be physically abused or even killed if they do not comply. The victims of human trafficking have no say as to whether or not they are trafficked and have no freedom to oppose such abuse. They themselves become the victims of modern-day sla very. Studies now show that oftentimes traffickers are motivated because human trafficking is extremely profitable, and it is very low risk because many people are unaware that they might be trafficked (NHTH). I myself was one of those people who had no idea that sex trafficking was as popular as it is. Growing up, I would watch a lot of crime shows occasionally seeing episodes based off of sex trafficking rings and would think to myself â€Å"Man, I’m so happy that doesn’t happen anywhere around here.† I have never been more wrong. In 2018, 14 people were rescued in Hemet, CA from a sex trafficking ring. The three traffickers would physically, emotionally and sexually abuse their victims and forced them to endure horrific sexual exploitation. Of the 14 people who were rescued, 10 of them were minors (Riverside County News). Upon finding this out, I was completely shocked and disgusted. But what surprised me more was that the average age somebody enter human trafficking is between the age of 11-14 (AHC). I thought of myself at the age of 11 when there seemed to be no cares in the world- no bills, no drama or no work to go to. All I cared about was finishing up my homew ork in enough time to go play outside with my friends. How is it fair that children, in the most innocent years of their lives are forced to sell their body’s out to other people when they should be having the time of their life? Without a doubt, the answer to the question is that it isn’t fair. Nobody should be stripped of the right to tell people no and nobody should be forced to do something that they don’t want to.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Never would I have ever realized that craving a bowl of cereal would open my eyes to the world that we live in as much as it has. I was one of the many people in the world who didn’t realize how common and local human trafficking really is. Traffickers don’t value their victims’ lives- and much less their opinions. They will devalue you in any way that they can as long as it benefits them in any way possible. Anyone, including yourself can be forced into human trafficking- whether it be through sexual or forced labor. Even though human trafficking is as rampant as it is, we still can’t live our lives in fear. It is important that we all pay attention to our surrounding environments while enjoying the life that we have. We’re only given once chance- so let’s make the most of it while we still can.  

How to Cite a Website in Oxford Referencing

How to Cite a Website in Oxford Referencing How to Cite a Website in Oxford Referencing With computers now everywhere, it’s common to cite a website or two in academic writing. And to do this with Oxford referencing, you’ll need two things: footnote citations and an entry in a bibliography. The format for Oxford citations may depend on which version you’re using, so remember to check your style guide if you have one. But if you’re not sure where to start, our guide to referencing a website should help. Referencing a Website in Footnote Citations Footnote citations are indicated via superscript numbers in the main text: This is how a citation should look in your document.1 The first time you reference a website, use the following format: n. Initial(s). Surname, â€Å"Page Title,† Website [website], publication date, section/paragraph number (if applicable), URL, accessed date. You should then end up with something like this: 1. P. Philips, â€Å"Going Beyond: How to Reach Mars,† Space Travel [website], 2015, www.spacetravel.org/mars-travel, accessed August 2, 2018. If the website has more than one author, use â€Å"and† to separate the final two: 2. A. Moretti and T. Pepe, Mars Remains an Unattainable Dream [website], 2016, www.spaceexploration.com/aliens, accessed September 6, 2018. If the website has four or more authors, use â€Å"et al.† after the first name: 3. W. Ellis et al., â€Å"Has NASA Finally Outdone Itself?,† The Big Questions [website], 24 June 2014, www.thebigquestions.org/NASA, accessed September 4, 2016. If quoting part of a web page, note the paragraph or section after the date: 4. T. Harper, â€Å"Experiencing Space,† Space from Above [website], 2014, para. 10, www.spacefromabove.com/experiencing, accessed September 5, 2018. Sometimes, you might not be able to find the author or date of publication for a page on a website. If this happens, use the publishing organization in place of the author and/or write â€Å"[no date]† in place of the date of publication: 5. Space from Above, â€Å"Endless Darkness,† Space from Above [website], [no date], para. 2, www.spacefromabove.com/void, accessed September 7, 2018. As shown above, if the publishing organization is the same as the website, you do not have to repeat this information after the page title. Subsequent Footnotes After citing a source once, you can use a shortened footnote format if you cite it again later in the document. One common approach is to give the author’s surname and a relevant paragraph number. Another approach is to use the Latin abbreviations â€Å"ibid.,† â€Å"op cit.,† and â€Å"loc. cit.†: Ibid. (meaning â€Å"in the same place†) – We use this to cite the same source twice in a row. These are known as consecutive citations. Make sure to include a new page number if you’re citing a different part of the same text. Op. cit. (â€Å"in the work cited†) – Used for citing a different part of the text in a non-consecutive citation (i.e., when you have cited at another source since the initial footnote). Give this after the author’s surname. If you have cited more than one source by the author, include a shortened source title. Loc. cit. (â€Å"in the place cited†) – As above, but we use this one when citing the same page as in the initial footnote citation. If you have one, it is worth checking your university’s style guide to see if it specifies a shortened citation format. But whichever method you use, make sure to apply it consistently in your document. Adding a Website in an Oxford Bibliography At the end of your document, you should add all cited sources to a bibliography. The format to use here for a website is as follows: Surname, Initial(s), â€Å"Page Title,† Website Name [website], date of publication, URL, accessed date. In practice, then, the bibliography entry for a website would look like this: Philips, P., â€Å"Going Beyond: How to Reach Mars,† Space Travel [website], 2015, www.spacetravel.org/mars-travel, (accessed August 2, 2018). As with footnotes, if a website doesn’t have a named author, use the publishing organization. If there is no date, write â€Å"[no date]† to show this.