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Sample Case Study Analysis

Case Study 2

A 43-year old male sheep-farmer presents to his general practitioner complaining that he is “going yellow”. He first noticed this one week previously. He has no other symptoms.

Until last year this man lived and worked in rural Greece, but he retired to the United Kingdom to be close to his family. Other than coming to the UK he has never travelled outside mainland Europe.

Physical examination reveals mild jaundice and a moderately enlarged liver, which is otherwise entirely normal. An abdominal ultrasound examination reveals the presence of a 9cm fluid-filled cavity within the right lobe of his liver and dilated intrahepatic bile ducts, and is otherwise normal. Computed Tomography (CT) scanning confirms the presence of a 9cm liver cyst and dilated bile ducts, but again is otherwise normal.

What two parasitic (i.e. helminthic or protozoan) diseases are most commonly associated with large fluid-filled masses in the liver?

echinococcus-granulosus

The most common causes of fluid filled masses in the liver are Echinococcus granulosus and Entamoeba histolytica.

Based on epidemiology and clinical findings, which is the most likely parasitic diagnosis in this case, and why?

The most likely diagnosis is Echinococcus granulosus as the patient has developed a liver cyst which the parasite is most commonly associated with. Entamoeba histolytica is more commonly associated with liver abscesses.

Describe in detail how this disease is acquired

Echinococcus granulosus is most common in areas of sheep and cattle farming. The eggs of Echinococcus granulosus are ingested by humans by contact with faeces from an infected animal (usually dogs and sheep), by direct contact with animals that are infected (e.g. contaminated fur) or by plants that have faecal contamination containing the eggs of the organism.

The disease (Cystic Echinococcosis) is caused by the metacestode stage of the life cycle, this is a cyst containing hydatid fluid. Soon after ingestion of the eggs the metacestode develops, this begins as a small vesicle and over time inflates in size until a granulotomous reaction in the host is induced. A fibourous tissue reaction follows along with the development of a connective tissue layer called a pericyst (Eckert & Deplazes 2004). The cyst gradually grows in size over time, and a range of symptoms can be observed mainly due to the pressure applied to the liver (Goering et al 2008).

4. Give a full account of the diagnostic methods that are available to confirm this diagnosis, and suggest specific test(s) that should be undertaken in this patient.

CT or ultrasound scans and radiography are important in detecting cysts caused by this organism and a CT scan was performed with the patient. Serological tests can also be performed for the diagnosis of Echinococcus granulosus, including ELISA, hydatid immunoelectrophoresis, latex agglutination and indirect haemagglutination test, but the results for these are sometimes not reliable. Immunoelectrophoresis and immunoblotting are now along with ELISA more common to use in diagnosis. The condition can also be diagnosed morphologically by staining with trichrome stain or Ziehl-Neelsen stain. These stains make the protoscoleces (hooklets) more easily recognisable. Finding these protoscoleces in fluid leaked out from the cyst is another way to confirm the presence of the organism (Brown 1996 & Goering et al 2008, Eckert & Deplazes 2004, Zhang et al 2003). An ELISA test could be performed to detect any antibodies to the parasite. Immunoblotting could also be performed to confirm the diagnosis.

5. Describe the life cycle of the infecting organism as fully as possible, using appropriate terminology. Compare and contrast this life cycle with that of Taenia saginata, the beef tapeworm.

The adult phase of the organism is a tapeworm that resides in the digestive tract of dogs. The adult tapeworm releases eggs into the faeces that are unknowingly consumed by an intermediate host e.g. sheep, pigs, or humans etc. The eggs then hatch in the host intestine and the oncospheres larva pass through the gut wall. The oncospheres travel to the liver via the blood or lymphatic vessels, but can also cause problems in the lungs, eyes, brain and other organs. The oncospheres then reach the liver and continue to grow, and becomes encysted becoming the metacestode phase. The parasite is usually passed back to the canid by the consumption of offal from the intermediate host. The consumption of herbivores e.g. sheep by humans results in the transmission of the parasite and the human host is a dead end for the life cycle. (Goering et al 2008, Brown 1996, Eckert & Deplazes 2004, Zhang et al 2003).

The life cycle of Taenia saginata has distinct similarities and differences. The parasite resides in the intestine of animals and humans and they shed proglotids which contain many eggs which are subsequently passed out along with the faeces. This results in the contamination of soil and water where the proglotids release the eggs. These are consumed without knowledge by the intermediate host which is very similar to Echinococcus granulosus. The eggs hatch in the intestine and the oncospheres pass through into the blood to reach other tissues and organs in the body and become encysted. This is also very similar to the equivalent life cycle stage of Echinococcus granulosus. The main difference is that humans are not a dead end host as if the meat contaminated with cysts of Taenia saginata is ingested the cysticerci are released at an adult tapeworm develops after attachment to the gut wall. This completes the life cycle of Taenia saginata (Cox, FEG 2002).

Give a full account of the treatment options that are available for this disease, and the possible complications of the disease and/or its treatment.

Surgery is the most desired treatment to remove the cyst from the liver and can result in the complete eradication of the parasite. Before surgery is performed, albendazole and praziquantel is sometimes given and then for one month and two weeks respectively after surgery. This should also be given after surgery for the same amount of time, the reason for this being that by sterilising the cyst the risk of anaphylaxis due to the release of fluid from the cyst is reduced along with the tension of the cyst. This can also decrease the risk of the cyst reappearing after surgery by eliminating the organism (Pan & Hunter 2007). If surgery is not performed correctly and larvae are released they can go on to cause infection in other parts of the body (Goering et al 2007). Surgery is not possible in some cases of the disease, for example if a patient has multiple cysts or is unable to undergo surgery for whatever reason. In these cases PAIR (Puncture-aspiration-injection-reaspiration) technique can be preformed, this involves the puncture of the cysts with a needle, this allows some drainage of the cyst. An antiparistiocidal solution is then injected into the cysts, this solution consists mainly of ethanol but NaCl can be used alternatively. There is then reaspiration of the fluid in the cyst. During and after this procedure albendazole should be given to prevent secondary infection. Percutaneous thermal ablation is also a technique which could be used.

For patients where cysts are inoperable, treatment with benzimidazoles is undertaken. After this treatment the patient may relapse but the disease can be treated again (Eckert & Deplazes 2004).

References

Brown,S (1996). Medical Microbiology. 4th Edition. Churchill Livingstone Inc. USA. Accessed from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=mmed&part=A4689#A4698 on 11th November 2009.

Cox, FEG (2002). History of Human Parasitology. Clinical Microbiology Reviews. 15(4): 595-612

Eckert, J & Deplazes, P (2004). Biological, Epidemiological, and Clinical Aspects of Echinococcosis, a Zoonosis of Increasing Concern. Clinical Microbiology Reviews. 17(1): 107-135

Goering, RV, Dockrell, HM, Zuckerman, M, Wakelin, D, Roitt, IM, Mims, C & Chiodini, PL (2008) Mim’s Medical Microbiology. 4th Edition. Elsevier, China.

Z. Pan & W. J. Hunter (2007): Hydatid Cyst Of The Liver: A Case Report And Review Of The Literature. The Internet Journal of Parasitic Diseases. Volume 2; Number 1. Accessed from http://www.ispub.com/journal/the_internet_journal_of_parasitic_diseases/volume_2_number_1_48/article/hydatid_cyst_of_the_liver_a_case_report_and_review_of_the_literature.html. on 11th November 2009.

Zhang, W, Li, J & McManus, DP (2003). Concepts in Immunology and Diagnosis of Hydatid Disease. Clinical Microbiology Reviews. 16(1): 18-36

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Logos, Ethos, and Pathos

When we look at an argument, there are often three distinct ways a rhetor can build an argument.  This is not to say that these three modes are exclusive, simply that we can always boil down any argument or piece of rhetoric into at least one of these three components, and quite often, the most successful pieces of rhetoric utilize all three.

Let’s look at a hypothetical situation first:

You and three friends are hanging out, and you all decide to go eat.  You have absolutely no opinion, but since you are driving, the decision is ultimately up to you.  Each of your friends attempts to persuade you to choose their restaurant.

Friend A says: “Well, Tommy’s is by far the closest restaurant to where we are right now, and so it saves us both time and it saves you gas money.  Tommy’s is also relatively inexpensive, so we could each eat for less than ten dollars.  This is likely going to be the cheapest restaurant available.  Tommy’s is clearly the best choice as it saves us money and time.”

Friend B says: “But Tommy’s only serves meat, and meat is murder! Don’t you feel bad for those poor cows? They are raised in tiny pens, forced to sit and eat most of their lives, and then they go off to a slaughterhouse!  It is so barbaric that we eat processed, mechanical meat like that.  We’d all feel better if we went to Vegan Joe’s.  Everything there is totally animal free, so we could all feel good about not hurting animals in any way.  We’ll all feel much better afterwards, I promise.”

Friend C says: “Seeing as I’m only one class away from getting my AS in Nutrition, and I am going to be going to UCLA next semester to get my BS in Nutrition, I think we should go to Robin’s.  From my view, everything there is healthier for you, and also, it would be far fairer if we went to a place where everyone can eat whatever they want.  Robin’s serves plenty of vegan meals as well as burgers, so this is the most fair answer, and again, it is definitely the healthiest. Trust me, I know.”

Who do you side with?  Each of these arguments is one of the modes personified, meaning that they are attempting to be pure in one way or another.  Really, what we are seeing are the Rhetorical Appeals in action.

The Rhetorical Appeals are the three basic “types” or “styles” of persuasion that we use.  They are Logos, Ethos, and Pathos.  Each of these appeals serves to target a specific aspect of our humanity, and each has a distinct character and system.

Logos is logic, or rather the mind. When we use Logos, we are attempting to use logic to prove our position to be true. Logos prefers to use logical constructs like deductive reasoning as well as quantitative data like numbers.   Logic is very much about showing what can be proven in empiric ways, meaning not something that can be interpreted. Friend A is focusing on data that he knows cannot be disproven logically, namely that Tommy’s is in fact closer (1 mile is always going to be less than 2 miles), and that Tommy’s is cheaper (ten is always going to be less than 15).

The advantage of Logos is clear: You can be logically correct. If you utilize logos properly, you can empirically prove that your position is valid, if not sound. This gives you a huge advantage as you can point to almost irrefutable evidence quite often.

The disadvantage is also clear: humans are not logical creatures. Humans will often behave in irrational ways, and again, we all have heard perfectly logical arguments and still chosen not to listen to them. You can be as logical as you want, but plenty of people will refuse to listen. Try being logical with a child and see how far that gets you.

Pathos is passion, emotions, or rather, the heart. When we use Pathos, we are attempting to make our audience feel a particular way, and we are hoping that because they feel something, they will listen to our position.   When we try to scare people, we use Pathos. When we try to guilt people, we use Pathos. Even trying to create lust, namely the old adage that sex sells, we are using Pathos.   Friend B is focusing on making us feel bad for wanting to eat meat and offering us the chance to feel good for not doing so. Friend B is clearly trying to just make us emotional, and he/she offers no logical evidence why Vegan Joe’s is the best choice. Friend B is simply trying to make us feel guilty and hope that the guilt we feel influences our decision.

The advantage of Pathos is that humans are inherently emotional creatures. We can control how we react to our emotions, but we cannot control what we feel. You cannot necessarily stop feeling anger that someone said something cruel to you, but you can control how react to that anger. Since we are emotional creatures, pathos can very easily make us feel many things, and again, not everyone is very good at controlling their reactions to emotions. This is again particularly true with younger humans. Everyone feels, and many emotions can cross cultural barriers as most people will feel sad if they see a puppy getting kicked.

The disadvantage of Pathos is that emotions are very much like a drug: They hit hard at first, but you develop a resistance and need more. What scares you at first is not going to scare you as bad the second time, or the third, or the fourth. Eventually, an audience becomes dulled to specific emotions, so you have to work harder and harder to invoke them. Pathos works well in the beginning, but it fades very quickly.

Ethos is ethics and character, or rather the soul. When we use Ethos, we are attempting to do one of two things: We either want to show that the argument is inherently fair or socially acceptable (ethics), or we want the audience to respect and identify with the speaker. When you see a celebrity endorsement, you are seeing Ethos at work. When you see someone throw around their credentials or experience, that is Ethos at work. When someone is trying to make it clear what is the most socially acceptable or socially favored decision, that is Ethos. Friend C focused on his/her own experience as a student to justify their decision. Friend C did not offer any specific information, simply his/her own weight as being learned in the matter. Friend C also emphasizes what is “fair”, an important ethical concern in American culture. Friend C is not offering numbers like A or emotions like B, but instead is offering something a bit more complex.

The advantage of Ethos is that humans are inherently social creatures. We cannot help but want to belong with other people, and we have an innate drive to be around others in some form. Ethos appeals to this by trying to place us on the side of society, making us feel secure and that we belong. We also cannot help but want to emulate those we respect, our leaders, as humans are also inherently hierarchal creatures. We want to be like those we value, and we want to reject those we devalue. Ethos is very powerful, and we often are unaware of how much we are influenced by those around us and those we admire.

The disadvantage of Ethos is that character and ethics are subjective concepts, and they change quite easily depending on the audience. A strong ethical argument to one audience may be horrific or upsetting to another audience, so Ethos is very limited to specific societies and cultures. Ethos does not always translate well to a large audience, and it is very rare to find individuals that can transcend cultural or linguistic barriers.  Ethos is highly effective, but it is also highly limited.

These three appeals are the heart of argumentation, and any good rhetor is going to know how to mix and match all three together. As each has a specific weakness and strength, by mixing them together, a rhetor can create a very effective piece of persuasion.

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A Broadway Romance: A Personal Reflection

sample reflection paper

Love is usually coupled with a number of ups and downs. It is this series of ups and downs that have fascinated one of the greatest songwriters of musical theater Ted Sperling, who is an award winner of the Tony Awards to create a song cycle titled “A Broadway Romance.” The show was first performed at the Café Carlyle with the graceful performances of Rebecca Luker as Mary Poppins and Howard McGillin as the Phantom of the Opera. The music cycle is from a selection of only 14 tunes portraying how couples struggle with relationships.

There are many favorites that are missing from this honeyed potpourri but the musical exploration of a fictitious relationship of a couple yields the satisfying rewards. In the musical cycle Luker and McGillin tap effortlessly into the feelings that loving couples experience in their opening numbers of “Something’s Coming” by Leornard Bernsteins and Stephen Sondheim and “The Man I Love” by Ira and George Gershwin. Then the couple brings in the reminisces of meeting that special person for the first time by singing two songs by Jerry Bock and Sheldon Harbnick titled “Will He Like Me” and “Tonight at Eight.”Sample concert review essay

The cycle continues for a total of 70 minutes with the song choice ranging from the slightly predictable songs of first love to the least expected. However the best moment of the cycle is brought out when the performers are brought together to make a group of true magic. They portray how the love grows into something bigger and the joy of having kids in the process. They also tease if there is a way that one cam leaves the other but there is no reason. Instead they sing “Getting Married Today” symbolizing how important it is to get married.

In a nutshell, listening to “A Broadway Romance” puts you in a position of being totally in love. It is a song cycle arranged and organized which makes you feel like you are almost in love.

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Career Options found in Civil Construction

Sample Essay on civil engineering
Manage Projects

The growth of physical infrastructures in many countries has been on the realm of focus in the past two decades. It has been established that the effect of civil construction spans across the primary sectors that greatly influence the economy of any country. This ranges from infrastructural developments, telecommunication systems, sewerage and water supply systems. In all these sectors, career opportunities found for civil contractors is immense.

There has been a misconception that the civil construction industry only employs engineers and other unskillful laborers. But in reality, engineers are only the integral part of any construction work with the other departments requiring graduates with other qualifications such as accounting, financing, inventory management, township administration, garnering resources and even lawyers. Some of the career options in civil construction include:

Project Management

Any construction project requires a construction management profile which can manage all the aspect and organization of the project from the start to the end. The responsibilities of a project manager include managing employees, getting new contractors, creating a budget for the project, coming up with regular reports on the progress of the project and organizing the usage of the equipment. If you are willing to enter the construction industry as a project manager, you have to take a course that trains you the above skills and proper application of the skills.

Software programmers

engineering
Essay on careers in civil engineering

There are a wide range of software and applications used in civil construction. With the dynamism in technology and the increased demand for simplifying work, new softwares are being introduced every day. As a software programmer or system analyst, you can place your skills to the edge of the job market by coming up with software needed in a given construction project. Taking an extra course in building codes and standards, contract administration and value analysis can be helpful in acquiring an opportunity as a software programmer.

Financial management

There is no project that can run without any funding. No matter how much funds the vendor gives out, there is still need for a person to handle the monetary or financial aspects of the projects. Career options in this department include financial analyst, accountant, financial consultant, tax consultant and give any financial guidance required in the project.

Legal consultant

Every project requires a person to handle legal aspects. Being proficient in the law can allow you to become a legal advisor to explain all the law provisions of the civil construction industry. You can also be a lawyer to handle all the legal disputes that may arise in the day to day activities. Furthermore, it will be your duty to guide the project vendors in acquiring licenses and title to the project.
To sum it up, the civil construction industry is not constrained to engineers only. There are also other career options that a person can grow into. However, working in the civil construction industry requires a person be proficient in Algebra, English, Math and Social Studies.

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American Composers Orchestra

The American Composers Orchestra which is popularly known as ACO is an American orchestra band based in New York. It has been in the music industry for quite a long time of duration since the 1970s. The orchestra is known widely for being the only band in the world which is solely dedicated to creating, performing, preserving and promulgating music made by the American composers. The orchestra is large and organizes some of the biggest concerts in the U.S.

The ACO usually organizes its concerts mainly at the Carnegie Hall though there are also other venues where a couple of things are done including New Music Readings, educational programs, radio broadcast and recording. From these events, the orchestra is able to identify the new emerging and unknown composers from different regions to expose to the industry. In essence the aim here is to establish the lesser-known composers from the regional status and take them to a national or international status of orchestra music. They also expose the composer to the new trending styles reflecting the geographical differences and the temporal diversity.

orchestra essay 1In addition ACO is also an incubator of ideas where composers can deposit their ideas to be grown to something bigger and better. There is a lot of talent and research in the orchestra which acts as a catalyst to the growth and changes of the orchestra therefor the ACO acts as an advocate to the American composer and the music that they compose. Up to date ACO has held numerous concerts in which numerous performances from more than 500 new American composers been presented. These performances also include more than 100 performances of newly commissioned work and world premieres.

In a nutshell, attending the ACO concerts can have many benefits especially if you are a newly talented composer. Furthermore if you love orchestra music then this is one concert that you would never want to miss.

Read Also: Logos, Ethos, and Pathos