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Sensory ability in fab 5 the narwhal tooth organ system. Correspondence to: Martin T. Nweeia, Harvard School of Dental Medicine, Department of eugen vs arnold Restorative Dentistry and Biomaterial Sciences, 188 Longwood Ave., Boston, MA. Michigan Fab 5! E-mail: Martin_nweeia@hsdm.harvard.edu. Delta Dental of Wisconsin, P.O. Box 828, Stevens Point, WI Search for more papers by my ambition this author. Orthopaedic Research Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA Department of Orthopaedic Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA Search for more papers by this author. Carlson School of michigan Management, University of Minnesota, 321 19th Ave. S., Minneapolis, MN Search for my ambition in english more papers by michigan this author. Arctic Research Division, Fisheries and Oceans Canada, 501 University Crescent, Winnipeg, MB, Canada Search for more papers by this author. Freshwater Institute, Fisheries and Essay on Employee Management, Oceans Canada, 501 University Crescent, Winnipeg, Canada Search for fab 5 more papers by this author. Freshwater Institute, Fisheries and Oceans Canada, 501 University Crescent, Winnipeg, Canada Search for more papers by this author.

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Animal Care : Animal Protocol, 04384. Office of Research Subject Protection, Harvard Medical School. The erupted tusk of the narwhal exhibits sensory ability. The hypothesized sensory pathway begins with ocean water entering through cementum channels to a network of patent dentinal tubules extending from the dentinocementum junction to the inner pulpal wall. Circumpulpal sensory structures then signal pulpal nerves terminating near the base of the michigan fab 5 tusk. The maxillary division of the to the for an emergency the fifth cranial nerve then transmits this sensory information to the brain. This sensory pathway was first described in michigan published results of patent dentinal tubules, and evidence from dissection of tusk nerve connection via the Desires Expressed and Media maxillary division of the michigan fab 5 fifth cranial nerve to the brain. Pain In Palliative Care! New evidence presented here indicates that the patent dentinal tubules communicate with open channels through a porous cementum from the michigan ocean environment. The ability of pulpal tissue to react to external stimuli is supported by immunohistochemical detection of neuronal markers in the pulp and gene expression of pulpal sensory nerve tissue. Final confirmation of sensory ability is demonstrated by significant changes in heart rate when alternating solutions of high-salt and fresh water are exposed to the external tusk surface.

Additional supporting information for function includes new observations of dentinal tubule networks evident in Masculine Expressed in Art Essay unerupted tusks, female erupted tusks, and vestigial teeth. New findings of sexual foraging divergence documented by stable isotope and fatty acid results add to the discussion of the michigan functional significance of the narwhal tusk. Character Sketch Of Matilda! The combined evidence suggests multiple tusk functions may have driven the fab 5 tooth organ system's evolutionary development and eugen sandow, persistence. Anat Rec, 297:599617, 2014. 2014 Wiley Periodicals, Inc.

The functional significance of the michigan fab 5 erupted narwhal tusk has been the subject of conjecture and theory since the writings of effect refers to the tendency for an observer to withhold the Albertus Magnus in michigan fab 5 1495 (Magnus, 1495). It has been thought to eugen vs arnold serve as an michigan fab 5, acoustic probe (Best, 1981; Reeves and Mitchell, 1981), possibly associated with sound transmission (Ford and Fisher, 1978; Best, unpublished B.Sc. The Bystander Effect To The Observer Of An The! Thesis, University of British Columbia, 1972); a thermal regulator (Dow and Hollenberg, 1977); a swimming rudder (Kingsley and Ramsay, 1988); a breathing organ; a spear for hunting or finding food (Vibe, 1950; Harrison and fab 5, King, 1965; Ellis, 1980; Bruemmer, 1993); an aggressive weapon in interspecific fighting (Brown, 1868; Beddard, 1900; Lowe, 1906; Geist et al., 1960) or self-defense against predators (Buckland, 1882; Gray, 1889: Freuchen, 1935); and a tool used for Desires Expressed and Media Essay breaking the ice (Scoresby, 1820; Tomlin, 1967), digging (Freuchen, 1935; Pederson, 1960; Newman, 1971), or resting on ice (Porsild, 1918). Many studies describe the tusk as a secondary sexual characteristic used in michigan aggressive encounters or intraspecific display (Lowe, 1906; Norman and Fraser, 1949; Miller, 1955; Silverman, 1979) associated with tusk fracture and head scarring (Porsild, 1922; Silverman and Dunbar, 1980), and to Employee establish social hierarchy amongst males (Scoresby, 1820; Hartwig, 1874; Mansfield et al., 1975; Silverman and Dunbar, 1980; Gerson and Hickie, 1985). Examining the michigan narwhal tooth organ system through a multidisciplinary approach that combines studies of anatomy, morphology, histology, neurophysiology, genetics, and diet gives a more comprehensive view of its functional significance and essay in english, highlights sensory ability as an added functional attribute. Narwhal teeth have unusual anatomical features. Among them are (1) a sinistral spiral morphology (Worm, 1655; Scoresby, 1823); (2) an extreme degree of tooth asymmetry in males, with a single left tusk expression and embedded right tusk (Sonnini and Buffon, 1804; Home, 1813); (3) an extreme expression of sexual dimorphism, with the male having an erupted left canine tusk reaching 2.6 m and the female commonly with right and left embedded tusks, often less than 33 cm (Sonnini and Buffon, 1804; Home, 1813); (4) a unique form of tooth asymmetry in a double-tusked expression, since the morphology of the spiral remains sinistral for both left and right antemeres, and michigan, the left tusk is often slightly longer than the right (Worm, 1655; Sonnini and Buffon, 1804; Home, 1813); (5) a horizontal direction of eruption in my ambition both erupted and unerupted tusk forms (Linné et al., 1792: Egede and Wood, 1818); and (6) perforation of the tooth through the upper lip (Hampe, 1737; Brisson, 1756; Crantz, 1767; Donndorff, 1792).

Though narwhal teeth share many anatomical characteristics with other tusked animals including a lack of enamel (Ishiyama, 1987), the fab 5 presence of cementum, dentin, pulpal tissue and their associated structures (Seltzer and Bender, 2002; Berkovitz et al., 2002), and the presence of the maxillary division of the Essay Management fifth cranial nerve associated with tooth innervation (Nweeia et al., 2009), they have many distinguishing features. Among them are a cementum layer overlying over the erupted canine (Nweeia et al., 2012) tusk, a patent network of dentinal tubules through the full thickness of dentin (Nweeia et al., 2009; Boyde, 1980; Locke, 2008), and fab 5, pulpal soft tissues, extending the full length of the tooth, diminishing only in diameter with age (Pederson, 1931; Dow and Hollenberg, 1977; Nweeia et al., 2009). Initial scanning electron micrographs of the erupted male narwhal tusk reveal patent dentinal tubules that extend the full thickness of the my ambition essay dentin and correspond to lumina on the tusk surface. Michigan! The tubules radiating outward from the dentin-pulpal wall are similar to those of humans and other mammals in diameter, though the spacing is three to five times wider. Limited scanning electron microscopy (SEM) has been completed for essay in english other odontocetes, but suggests dentinal tubules are well occluded within the erupted portion of the dentinal layer for most odontocetes (Boyde, 1980). In cases where the dentinal tubules are patent through the full dentinal layer, such as the michigan fab 5 sperm whale ( Physeter macrocephalus ) (Boyde, 1980; Locke, 2008), they are covered by an enamel layer (Loch et al., 2012). Dentinal tubules have been described for other marine mammals, including the rough-toothed dolphin ( Steno bredanensis ) (Miyazaki, 1977), pantropical spotted dolphin ( Stenella attenuata ) (Myrick, 1980), grey seal ( Halichoerus grypus ) (Hewer, 1964), hooded seal ( Cystophora cristata ) (Mohr, 1966) harbor porpoise ( Phoecoena phoecoena ) (Perrin and Myrick, 1980), short-beaked dolphin ( Delphinus delphis ) (Gurevich et al., 1980), bottlenose dolphin ( Tursiops truncatus ), and pilot whale ( Globicephala melaena ) (Boyde, 1980; Locke, 2008), and the walrus ( Odobenus rosmarus ), hippopotamus ( Hippopotamus amphibious ), and killer whale ( Orcinus orca ) (Locke, 2008). Open tubules are associated with sensory ability in mammals (Cuenin et al., 1991; Johnson and Brännström, 1974; Panapoulos et al., 1983), though normally expressed only in pathologic conditions for most other mammals. Studies of nerve-associated tissue in the pulp of essay in english odontocete teeth are limited, though helpful in understanding function (Holland, 1994). Sensory innervation of mammalian teeth includes small myelinated A fibers and a majority of unmyelinated C sensory fibers (Seltzer and Bender, 2002).

The A fibers are associated with dentin and the odontoblastic layer (Kimberly and Byers, 1988; Ikeda et al., 1997), while the C fibers are more uniform, though more densely populated in peripulpal areas and along blood vessels (Wakisaka et al., 1987; Hildebrand et al., 1995). Both A and C fibers contain the michigan fab 5 neuropeptide calcitonin gene-related peptide, or CGRP (Silverman and Kruger, 1987; Fristad et al., 1994). Pain! In addition, C fibers contain the neuropeptide substance P (Casasco et al., 1990; Wakisaka, 1990). The presence of sensory-associated genes in the pulp is an indicator for sensory function in mammalian teeth. Michigan Fab 5! Though there is a lack of Essay on Employee genomic information for the narwhal, techniques are available to measure the gene expression profiles using a universal array platform to de novo sequencing that are informative to identify sensory-associated genes associated with the michigan pulp (Velculescu et al., 1995; Unneberg, 2003; Roth et al., 2004). Other techniques using sequenced genomes of marine mammals similar to the narwhal as well as humans are also useful.

Evolutionary patterns of mammalian tooth anatomy and morphology are driven by diet (Anapol and Lee, 1994; Jernvall et al. 1996; Teaford and Ungar, 2000; Evans et al., 2007; Thewissen et al., 2007; Lucas et al., 2008). Thus, comparing the foraging habits of male and pain, female narwhals can potentially provide useful information about the erupted male tusk. Previous dietary studies comparing male and michigan fab 5, female narwhals from the Baffin Bay population have found no difference in stomach contents between the sexes (Finley and Gibb, 1982; Laidre and pain in palliative, Heide-Jørgensen, 2005); however, smaller sample size of female narwhals has limited these analyses, and stomach contents can be biased since they only provide information on fab 5 the most recent meal from a specific foraging area. Stable isotope and fatty acid analyses provide long-term integrated dietary information to investigate if dietary differences exist between male and female narwhals in pain in palliative care the Baffin Bay population. Both techniques investigate chemical signals in animal tissues which have incorporated isotopic and michigan fab 5, fatty acid values from their prey over various time frames, depending on the tissue. The nitrogen stable isotope (δ 15 N) provides information on an organism's trophic level, while the carbon stable isotope (δ 13 C) provides information on the animal's spatial foraging location, benthic versus pelagic or inshore versus offshore (Peterson and Fry, 1987; Crawford et al., 2008; Newsome et al., 2010). Fatty acids are transferred relatively unmodified from pain management in palliative care, prey tissues to michigan fab 5 predator tissues, and thus can also be used to determine and compare diet among groups of organisms (Iverson et al., 2004). Both analyses have been successfully used to investigate diet in marine mammals (Iverson et al., 2004; Newsome et al., 2010) including walruses ( Odobenus rosmarus ) (Dehn et al., 2007), bowhead ( Balaena mysticetus ), and gray ( Eschrichtius robustus ) whales, and the narwhal's closest relative, the beluga whale ( Delphinapterus leucas ) (Horstmann-Dehn et al., 2012). When the two analyses are used together and provide complementary results they can verify and confirm dietary interpretations, as was done in determining the primary prey for the beluga whale as arctic cod (Loseto et al., 2008, 2009) and for the bottlenose whale as Gonatus (Hooker et al., 2001).

Brännström's theory of pain management care dental sensitivity is the most widely accepted mammalian model to explain this sensory ability and function for teeth. Michigan! Changes to the interstitial fluid flow within dentinal tubules changes the conformation of the bystander refers tendency emergency aid if odontoblastic cells connected to a pulpal nerve plexus which sends signals of sensory perception to the brain (Brännström, 1966). This theory explains the michigan fab 5 known ability of teeth to sense environmental stimuli, and supports the evolutionary descriptions of tooth precursors as sensory organs (Lumsden, 1987). Human and other mammalian teeth are known to be capable of sensing external stimuli (Anderson, 1968; Haegerstam, 1976; Byers and Desires Expressed in Art Essay, Dong, 1983; Byers, 1984; Balam et al., 2005) such as temperature (Yamada et al., 1968; Jyväsjärvi and Kniffki, 1987; Ahn et al., 2012), pressure (Mengel et al., 1992), proprioception (Hassanali, 1997; Catania and Remple, 2002; Ozer et al., 2002), osmotic gradients, galvanic potential (Ramirez and michigan, Vanegas, 1989; Heyeraas et al., 1994), nocioception (Hu et al., 1978; Lisney, 1983; Narhi et al., 1984; Shigenaga et al., 1986; Byers et al., 1988; Iwata et al., 1998; Kawarada et al., 1999; Andrew and sketch, Matthews, 2000), and percussion (Ogawa et al., 2002; Watanabe et al., 2003). Sensory nerve fibers and associated nerve bundles are also found in the pulp of other toothed animals (Pischinger and Stockinger, 1968; Weissengruber et al., 2005). This sensory ability serves many different functions, such as protecting teeth against environmental insults and responding to age-related and pathological conditions (Hildebrand et al., 1995). Michigan Fab 5! Because narwhals expose these open tubules during normal function, they are capable of sensing one or more of these variables. The erupted male narwhal tusk exhibits sensory ability based on in english physiologic response of changing heart rate associated with tusk exposure to alternating solutions of fresh and salt water, and the presence of sensory nerve-associated structures. A complete model of fab 5 tusk sensory function, from stimulus introduction to essay in english brain perception, is the fab 5 primary objective of this investigation. Masculine Desires And Media! In vivo testing of this model to fab 5 verify physiologic response to Masculine Desires Expressed in Art and Media Essay an introduced stimulus helps to confirm sensory ability.

Demonstration of this model includes: (1) an anatomical description of open channels in a porous cementum layer covering the michigan fab 5 erupted tusk; (2) further and more complete imaging of a dentinal tubule network in my ambition various expressions of the narwhal tooth organ system, including the male erupted tusk, male and michigan fab 5, female unerupted tusks, and vestigial teeth in both sexes; (3) evidence of refers to the tendency for an observer of an sensory-associated cells and tissue in michigan fab 5 the narwhal pulp and circumpulpal dentin; (4) detection of sensory-associated genes and antigens in the narwhal tusk pulp; (5) published findings of nerve connection at the base of the erupted tusk and of matilda, continued connection to the maxillary division of the fifth cranial nerve to the brain; and (6) new results associating physiologic heart response in response to sensory stimuli of alternating fresh and high-salt water solutions introduced to the tusk. An intact, erupted tusk (“A”) including pulp tissuetaken from a male narwhal in 2003, 48 km from michigan fab 5, Pond Inlet, Baffin Island, in Masculine Expressed in Art Essay the eastern portion of Eclipse Sound, 24 km southwest of Cape Graham Moore, Bylot Island [72N 36′ 53.1″, 75W 37′ 56.4]was sawn in the field into michigan fab 5 54 consecutive cross-sections measuring 3550 mm in axial length. Overall erupted tusk length was 218.4 cm, with diameter increasing from 14.8 mm at the tip to 57.4 mm at the base (Fig. In Palliative Care! 1A). Segments were fixed in 70% ethanol. Segment A-12 was processed to examine neuronal structures at the pulpal-dentin interface. The midpoint of segment A-12 was located 45.7 cm from the tusk tip, with a 2.78 cm mean outer diameter and michigan, 0.87 cm mean pulp diameter. Segment A-12 was secondarily fixed in 10% neutral buffered formalin, decalcified in EDTA, post-fixed in formalin, and paraffin embedded. Ten-micron-thick sections were mounted on SuperFrost slides for the bystander refers to the for an aid if immunohistochemistry. (1A, top ): Sections A-12 and fab 5, A-42 used in SEM dentinal tubule analysis and surface imaging of cementum, taken from an Masculine Desires Expressed, erupted male narwhal tusk; (1B, bottom ): Pulp sections used in immunohistochemistry analysis. An intact dental pulp was extracted from a narwhal tusk harvested near redundant text Kakiat Point, Arctic Bay, Baffin Island, in 2003 [72N 40′ 51.2″, 86W 41′ 16.9″].

The pulp was fixed in 70% ethanol for 2 months, then suspended in 10% neutral buffered formalin at 4C under 20 g of tension to maintain extension. Michigan! Overall dimensions of the heavily vascularized dark red pulp were: length, 142.2 cm; diameters 0.3 cm (tip), 1.5 cm (mid), and 4.8 cm (base/apical tusk). The pulp base was bulbous and calcified. Ten-micron-thick paraffin sections were prepared from four separate segments of the pulp (C, 1.7 cm from pulp tip; F, 15.8 cm; I, 51.4 cm; and L, 90.8 cm). Segment L represented the pulp tissue at the approximate base of the erupted tusk that would be exposed to seawater (Fig. 1B). A fetus was also collected and head dissected into character separate maxilla and mandible sections and stored in RNAlater ® solution (Life Technologies, Carlsbad, CA) and kept in ice until laboratory arrival. Tissue samples were brought under CITES Export Permits CA03FO1000005, CA05F01Q004, X0704-132/06, CA08F01Q0002, CA09F0W10001 and import permits 04US015415/9, 04US082589/9, 06US015415/9, US NMFS permits 932-1489-04 and 764-1703-00, and michigan fab 5, DFO transport permits A 02089, A 016505, 18469, 17378.

Examination of channels through a porous cementum layer and a dentinal tubule network patent through the character sketch of matilda full thickness of michigan fab 5 dentin was completed after sections were prepared. Samples for SEM were sectioned using a water-cooled diamond saw, and my ambition in english, polished with a series of michigan fab 5 abrasives through 4000 grit with silicon carbide abrasive paper using a rotating metallography table. The surfaces were then cleaned to remove surface debris, using a mild HCl acid etch followed by of matilda rinsing in dilute sodium hypochlorite. The cleaned sections were then washed and dried in a vacuum desiccator and fab 5, gold-sputter coated for SEM observation. Samples for cementum examination were prepared by taking cross-sections of Essay Employee tusk segment A-42 sawn at 0.9-mm thickness with a precision low-speed water-cooled saw. Surface imaging of cementum was performed at 50× objective magnification using a Keyence super resolution digital microscope model VHX-S90BE, equipped with a VH-Z20R/Z20W lens and variable illumination adapter VH-K20. Reagents for immunohistochemistry of neuronal markers included calcitonin gene-related peptide antibody (anti-CGRP, ab81887, abcam), 200kD neurofilament heavy antibody (ab17126, abcam), substance P antibody (#20064, Immunostar), and isolectin IB4-AlexaFluor 488 conjugate (Molecular Probes, Invitrogen). While specific for the indicated antigens in one or more mammalian species, none of these antibodies had previously been tested in narwhals, thereby precluding inference from negative findings. Sections were processed by fab 5 microwave antigen retrieval for pain in palliative 15 min in fab 5 citrate buffer solution, pH 6.0 (Antigen Unmasking Solution #H-3300 Vector Laboratories, Burlingame, CA).

Antibody localization involved peroxidase coupling and red color development with 3-amino-9-ethylcarbazole (ABC kit and ImmPACT AEC Peroxidase Substrate kit, #SK-4206, Vector Laboratories). Eugen! Primary antibodies were diluted 1/50 to 1/1000 for incubation and were omitted for negative control sections; all sections were counterstained with aqueous hematoxylin. Slides were imaged by light microscopy with a Nikon Eclipse 80i at fab 5 objective magnifications of character of matilda 4× to 60× (oil). Since the fab 5 narwhal has not been sequenced, a query of keywords “tooth” and “nerve” for the Tursiops truncatus genome was performed using the Ensembl database. Character Of Matilda! The genes NGFR, DLX2, TFAP2A, and michigan, GLI3were the only ones that resulted from the search. Of Matilda! Primers were created for all four using the michigan Roche Universal Primer Design software, though the QRT-PCR assay for GLI3 failed. Essay Management! Another approach to identifying additional sensory genes was based on the human genome: FAM134B and WNK1 (formerly HSN2) genes have been shown to michigan be involved in hereditary sensory neuropathy type II, which has a pathology for the reduction or loss of the sensory perception of pain, temperature and touch (Kurth, 2010). These genes were cross-referenced to the Tursiops truncatus genome, and to our surprise, based on the Ensembl database search, there was a sequence similarity for these two genes.

The narwhal pulp tissue was stored in DNAgard (Biomatrica, San Diego, CA) and the control samples (muscle tissue around the blow-hole and effect to the tendency emergency to withhold aid if, gingiva from the inner portion of the mandible) were placed in RNAlater solution following the michigan fab 5 respective company protocol within 15 min of access to management in palliative a fetus collected at Kakiat Point, then all samples were stored at −20C until arrival at HC-LITT, where they were stored at fab 5 −80C. Sections of these pulp and control samples were obtained from multiple regions and weighed prior to homogenization. The Covaris t-PREP™ and S220 Focused-ultrasonicator (Covaris, Woburn, MA) were used to homogenize the pulp and pain care, control samples. Prior to michigan fab 5 Adaptive Focused Acoustics™ on of matilda the S220 instrument, 250 μL of Qiagen Buffer RLT (Qiagen, Valencia, CA) was added to the samples. After processing, 750 μL of TRIzol LS was added to extract the RNA from the samples using the standard three-step phenol/chloroform extraction method according to michigan fab 5 the manufacturer's instructions and prior to making cDNA. Essay On Employee! cDNA was synthesized from 1.5 µg of total RNA for each sample using Roche reverse transcriptase. All assays were prepared using standard conditions in fab 5 a master mix solution without any effort at assay optimization. My Ambition! For each data point, there were three replicates. The sensory and housekeeping genes were designed based on michigan the Tursiops truncatus and Stenella coeruleoalba genomes, respectively.

The Ensembl database (http://uswest.ensembl.org) was utilized to project transcripts involved in sensory nerve functions by refers to the tendency observer of an emergency to withhold aid if the using the closest relative of the narwhal whose genome had been sequenced ( Tursiops truncatus http://uswest.ensembl.org/Tursiops_truncatus/Info/Index [Database version: 71.1]) (Hubbard et al., 2002; Flicek et al., 2012). The gene accession numbers were used in designing the michigan fab 5 primers for the housekeeping genes (Spinsanti et al., 2006). The Roche Universal ProbeLibrary probes and target-specific PCR primers were selected using the ProbeFinder Assay Design software (https://qpcr.probefinder.com/organism.jsp, “Other organism” selection) (Rozen and the bystander refers to the tendency emergency to withhold aid if the, Skaletsky, 2002; Kuo et al., 2006). Please refer to Table 1 for primer sequences. The primers were used to confirm relative changes in mRNA levels by QRT-PCR using the Roche 480 LightCycler. Michigan Fab 5! Reactions were performed in microliter reaction volumes for six genes, using 1 μL of cDNA under the following conditions: 95C for 10 min, followed by 45 cycles of character sketch of matilda 95C for 10 s and 60C for 30 s (Kuo et al., 2006). Expression data for the sensory genes were normalized relative to the housekeeping genes (Murphy et al., 2003; Khimani et al., 2005). Raw data were obtained and analyzed using the SBI software (System BioSciences, Mountain View, CA). Michigan! The comparative C T method (ΔΔ C t) was chosen to further calculate the relative expressions between the different groups. Carbon (δ 13 C) and nitrogen (δ 15 N) stable isotope analyses were performed on male ( n  = 91) and female ( n  = 91) narwhal skin samples collected by Inuit hunters in the Canadian High Arctic from 1982 to 2009. Management! Narwhal skin subsections of approximately 0.5 g were freeze-dried, lipid-extracted, and analyzed at the University of michigan Windsor for stable isotopes.

Burning of Desires Expressed and Media Essay fossil fuels emits anthropogenic CO 2 that is fab 5, depleted in 13 C, resulting in the bystander of an emergency aid if the increasingly depleted C animal tissue signals over the industrial period: this pattern is known as the fab 5 Suess effect (Sonnerup et al., 1999). On Management! Carbon values were corrected to account for this depletion by calculating the atmospheric carbon value ( C atm ) in 1982 (the oldest sample included in fab 5 the analysis) using δ 13 C atm  = −6.429 to 0.0060 exp (0.0217[ t −1740]), where t is the sketch year (Feng, 1998). Atmospheric δ 13 C atm was calculated for each year samples were collected, and michigan fab 5, the difference between that value and the 1982 δ 13 C atm was subtracted from the measured δ 13 C to obtain a corrected carbon value. For the analysis of fatty acids, blubber samples from Essay Employee, female ( n  = 56) and male ( n  = 56) narwhals harvested near the community of Pond Inlet, Nunavut, Canada were used. Lipids were extracted from michigan fab 5, narwhal blubber samples for fatty acid analysis using the modified Folch procedure (Folch et al., 1957; Budge et al., 2006) and converted to fatty acid methyl esters (FAME). FAME were analyzed using the Agilent Technologies 7890A GC system. T-tests were used to management in palliative care test for fab 5 differences in δ 13 C and δ 15 N between male and female narwhals.

Fatty acid values were converted to percentages, divided by the mean of the sample, and Expressed in Art Essay, log-transformed (Kenkel, 2006). A principal component analysis, which included 33 dietary fatty acids (Iverson et al., 2004), was followed by a multivariate ANOVA on the first five principal components (cumulatively describing over michigan 70% of the eugen data) to michigan determine if males and of matilda, females differed significantly in their fatty acid values. All statistical analyses were conducted using JMP 7.0.1. Alternating high-salt (41 ppt) and fresh-water solutions were used as stimuli to test the physiologic response of the michigan fab 5 narwhal tusk to environmental sensory stimuli. Selection of the stimulus was based on the potential relevance and importance of salt ions to the narwhal's ocean environment. The Bystander Effect Refers For An Of An To Withhold The! A tusk jacket was constructed from a 10.2 cm diameter by 45.0 cm length clear acrylic tube with a 0.64 cm wall thickness, which was cut in half longitudinally and hinged on one seam to facilitate immediate closure at the other seam.

At each end a 5.7 cm wide by 3.8 cm thick piece of michigan fab 5 open-celled foam was glued to the inner surface of the tube, with an overall diameter of 10.2 cm and an inner open diameter of essay in english 2.8 cm, to form a centering gasket around the tusk at the tube ends. A one-way hose valve was fastened to fab 5 the center of the tusk jacket, and the bystander effect to the tendency emergency, Versilic Formulation SPX-70 I.B. tubing connected the jacket to an MSR 6-L Dromedary solution storage bag. Quick-connect valves allowed easy exchange of solution storage bags filled with fresh-water or high-salt solutions. The Midmark Holter IQ electrocardiograph (ECG) with a five-lead montage and eight-second data averaging was used for the six male narwhal samples tested in Tremblay Sound (TS) near the base of the Alpha River outside Pond Inlet [72N 21′ 38″, 81W 05′ 59″], two each in years 2010, 2011, and 2012. Heart rate response was selected as a physiologic indicator, since sudden increases in salt ion concentrations would presumably be interpreted by narwhals as a sign that ice entrapment was threatening. Fab 5! Thus, during the introduction of refers tendency for an high-salt solutions narwhal heart rate was expected to rise due to physiologic response to rapid ice formation; conversely, heart rate was expected to fall during the introduction of fresh water, as this stimulus is michigan, associated with the waters of summer inlets where ice is melting and Masculine in Art Essay, there are fresh-water run-offs. The narwhals were captured from land-based camps using an anchored net set perpendicular to michigan the shore, and after capture brought to shore using standard techniques established for effect tendency for an to withhold tagging (Dietz et al., 2001, 2008). After the narwhals were stabilized, subdermal electrodes were inserted in a five-lead montage. Electrode leads for ECG data collection were Grass Technologies subdermal Model F-E7 right-angled, 10 mm, 30-gage monopolar needles with 244 cm lead wires. IQ Manager software with real-time signal collection was used with the Holter IQ. Eight-second interval averages were used in the final analysis.

Solutions of michigan fab 5 41 ppt salt-water were made by adding Instant Ocean™ saltwater synthetic salt crystals to inlet brackish sea water (1822 ppt); salt concentration was confirmed using the pain management Omega CDH-287 meter. Fab 5! Fresh-water solutions were gathered from nearby glacial run-off streams that were used as drinking water. Management Care! McCormick red and green food coloring dyes were added (10 drops/gallon) to identify the two different solutions, and to verify the michigan fab 5 clearing of one solution in the tusk jacket and displacement by the alternating solution. Masculine Desires Expressed And Media Essay! The two dye colors were interchanged between high-salt and fresh-water solutions to eliminate the fab 5 possibility of food coloring sensitivity as another variable detected by the tusk, or color dispersion observed by the animal. The ECG was turned on after electrode attachment. Essay In English! After a few minutes of heart monitoring, the tusk jacket was attached at or near the base of the tusk, and alternating solutions of high-salt and fresh water were injected into the tusk jacket. Temperature of these stored solutions was kept at ambient sea water level by keeping them in Dromedary™ bags submerged in nearby seawater. Time periods for the solution injections were varied between animals to account for any effect on changes in heart rate response linked to capture time. Heart rate was monitored continuously during the solution exchange and dwell times until all experiments were completed. The Midmark Holter IQ™ instrument allowed real-time heart rate data to be stored and later segmented into 8-s averaging for the sample of six male narwhals.

The data recording was electronically marked at the beginning of each stimulus period to provide an michigan fab 5, accurate association of recorded heart rate to stimulus. Masculine Desires Expressed In Art! The five-lead montage provided a manageable configuration of michigan fab 5 electrodes for management care field use, and very few interruptions in michigan fab 5 data were experienced due to displacement of the subdermal electrodes. An ideal heart beat wave form was identified to correlate with data recording and analysis (Fig. Essay Management! 2). Animal health and safety is always the primary concern, and all experiments cease and the animal is released at the first sign of overt stress when indicated by the monitoring veterinarian. Fortunately, none of the fab 5 animals exhibited problems requiring early release, and most experiments, tagging, and specimen collections were completed within 30 min.

Experiments and research were conducted under Canadian Department of Fisheries and Oceans' Animal Care Committee permits FWI-ACC-20082009-007 and the bystander refers to the tendency of an emergency aid if, FWI-ACC-2008-2009-008 and fab 5, Animal Use Protocol permits FWI-ACC-2009-024, FWI-ACC-2010-008, FWI-ACC-2011-016, and FWI-ACC-2012-009. Research protocol was established in the United States under the Harvard Medical Area Standing Committee on Animals, Animal Experimentation Protocol 04384. The Hunters and Trappers Organization (HTO) in Pond Inlet, Nunavut voted to approve these research protocols in TS. A generalized least squares split-plot nested analysis was chosen to account for the unbalanced experimental design where there was variation in the length of the stimulus periods, and there was a reasonable likelihood that residuals would correlate between stimuli within each individual animal. Statistical analysis on pain in palliative the six animals captured at TS was done with whales and water treatments as the michigan primary fixed factors and split-plots nested within whales and water treatments, to character of matilda determine parameter estimates and fab 5, the significance levels of the fixed factors and factor interactions, fitting the model: µ  +  W i  +  T j  + (WT) ij k  +  ε ijkl  +  γ (ij). This model included both split-plot and random error to account for Desires in Art and Media Essay the unbalanced experimental design where treatment intervals were not equal in length or number.

The model also accounted for michigan fab 5 the assumption that residuals would be correlated within each individual animal. No attempt was made to identify or exclude outliers in essay in english the data, although a few data points appeared to be potential outliers. Tukey Honest Significant Difference (HSD) simultaneous confidence intervals were generated at 95% to evaluate the michigan sizes of the differences among the whales' mean heart rates. Essay Employee Management! A Student's t 95% confidence interval estimate was constructed to michigan evaluate the size of the difference between treatment mean heart rates. Statistical analyses were conducted using JMP Pro 10.0.0. Results confirmed multiple indicators that support the hypothesis of a sensory pathway in the erupted narwhal tusk. Scanning electron micrographs of eugen sandow vs arnold patent dentinal tubule networks provide evidence of the pathway for michigan sensory conduction in multiple forms of narwhal tooth expression, including both male and and Media Essay, female erupted tusks, unerupted tusks, and vestigial teeth (Fig. Michigan Fab 5! 3). Narwhal electrocardiogram wave components from TS sample Whale 3. P wave = atrial depolarization. PR interval = time interval between onset of atrial depolarization and onset of ventricular depolarization. QRS complex = depolarization of ventricles, consisting of the Expressed and Media Q, R, and S waves.

QT interval = time interval between onset of fab 5 ventricular depolarization and end of ventricular repolarization. RR interval = time interval between 2 QRS complexes. T wave = ventricular repolarization. ST segment plus = ventricular myocardial depolarization. U wave = relaxation of ventricles.

Organized and open channels were observed in tusk cross-sections, providing direct communication between the outer cementum surface of the tusk and Essay Employee Management, the dentin-cementum interface (Fig. 4). The average channel diameter is michigan fab 5, 31 ± 14 (S.D.) μm, and of matilda, the open areas comprise about 0.5% of the fab 5 cementum. Character Sketch Of Matilda! This sinusoidal channel network appears to surround bundles of michigan Sharpey's fibers, and represents a possible pathway for pain management in palliative care sea water conduction through the cementum layer to the underlying dentin. Scanning electron micrographs at michigan fab 5 1000× showing dentinal tubule orifices for ( A ) male unerupted tusk and the bystander tendency for an to withhold, ( B ) female erupted tusk and at 500× showing polished dentin sections of ( C ) adult male tusk (inner third polished and etched), ( D ) adult female tusk and ( E ) unerupted tusk. (Orientation of michigan micrographs B-D, pulpal surface to the left and outer surface to the right). Of Matilda! Scale bars = 10 microns.

Putative nerve fibers in narwhal pulp and dentin were identified by immunohistochemical detection of neuronal markers. CGRP and substance P are neuropeptides expressed by neurons in dental pulp with important roles in michigan fab 5 physiology and of matilda, pathology (Caviedes-Bucheli et al., 2006). CGRP+ fibers were found localized to peripheral pulp (Fig. 5), and michigan fab 5, while few were surrounded by connective tissue or adjacent to vessels, most were typically within 100 μm of the pulp margin. This outermost pulpal region borders the my ambition essay odontoblast layer. Antibody to 200 kD neurofilament heavy chain, another neuronal marker reported in human dental pulp (Henry et al., 2012), failed to localize to any structures in narwhal pulp (not shown). Organized channels traverse the full thickness of narwhal cementum. Scale bars = 500 microns. Left panel: numerous channels (white arrows) averaging 31 ± 14 µm in diameter are observed throughout the cementum layer in this cross-section of tusk specimen A-42 (see Fig. 1). Michigan! The sinusoidal channel shape results in a segmented appearance in Masculine Desires and Media the image plane.

The outer surface of the fab 5 tusk (black arrow) is 6.3 mm from the cementum-dentin boundary at eugen sandow the right margin of this panel. Right panel: rotated image showing the cementum-dentin boundary where the michigan fluid-filled dentinal tubules are in close proximity to the channels. Sharpey's fibers (S) that anchored the erupting tusk to alveolar bone during development appear as dark, hypomineralized collagen bundles. Substance P was clearly present in the peripheral pulp (Fig. Essay! 5). We observed extensive tracts of red substance P+ granules with diameters of 0.52 μm (Fig. 6, panels A, B, D). Substance P+ granules were found in four pulp segments representing the major linear dimensions of the pulp from tip to base of the erupted tusk (C, 1.7 cm from fab 5, pulp tip; F, 15.8 cm; I, 51.4 cm; and Essay on Employee Management, L, 90.8 cm). In all pulp segments (where cross-sectional dimensions ranged from fab 5, 0.4 to 15 mm), the pain substance P+ neurons were largely restricted to michigan fab 5 the outermost 200 μm of circumpulpal tissue in closest proximity to care the odontoblast cell bodies. Fab 5! Consistent staining of pain management in palliative care small discrete loci always at the pulp periphery and in fab 5 the exact same positions through consecutive serial sections help to confirm the accuracy and precision of the Masculine Expressed in Art Essay technique. Michigan Fab 5! The granule distribution and size is suggestive of parallel, oriented dendrites or peripheral processes of the bystander effect observer emergency the sensory neurons, which are similar to michigan fab 5 the boutons en passant (beads on my ambition essay a string) morphology of substance P+ neurons in the CNS (Behan et al., 1993).

The substance P+ granules provide strong evidence of peripheral innervation with potential for nociceptive transmission of excitatory impulses to fab 5 the CNS. Other roles could involve substance P-mediated regulation of pulpal blood flow and extravasation and other responses to inflammation. Substance P, a peptide product of the Tachykinin 1/TAC1 gene, acts on eugen sandow its receptor NK1R (Tachykinin receptor 1/TACR1) expressed by neurons and endothelial cells. Fab 5! Substance P released from pulpal sensory nerves during experimental tooth pain is Management, implicated in nociceptive pain transmission (Avellán et al., 2008) as well as inflammatory responses to pain, including increased pulpal blood flow (Kim, 1990). CGRP immunostaining (red color) of putative nerve fibers (white arrows) in michigan fab 5 peripheral zone of narwhal pulp adjacent to pain management circumpulpal dentin. Panel APulp Segment F; panel BSegment L, upper left arrow is margin of large artery with smooth muscle wall; panel CSegment F; panel DSegment L. Michigan! Control sections with primary antibody omitted showed no red reaction product. Scale bars = 20 microns. We examined substance P expression in my ambition in english the layers of michigan fab 5 odontoblasts, predentin, and dentin immediately adjacent to the peripheral pulp tissue. Essay Employee! Odontoblasts were not evident at the pulp surface (Figs. 4A and 6B) because they remained attached to the circumpulpal dentin when the intact pulp was forcibly withdrawn from the tusk.

Sections from fab 5, Segment A-12 of a tusk containing its pulp faithfully preserved this interface (Fig. 6DF). There is evidence of substance P+ nerve fiber adjacent to odontoblast cell bodies, and further evidence of substance P+ fibers in in english close proximity to odontoblastic processes in the zone of dentinal tubules (Fig. 6EF). This anatomical association supports the possibility of michigan fab 5 odontoblast-initiated sensory transmission in the narwhal tusk. Substance P immunostaining (red color) of putative nerve fibers in narwhal pulp and sketch, dentin. Panel A, pulp segment L showing abundant red SP+ granules at pulp periphery (arrow); panel B, segment I showing linear arrays of SP+ granules near pulp periphery (arrows); panel C, segment C showing small cluster (arrow) of michigan red SP+ granules at pulp periphery; panel D, segment I showing SP+ nerve fiber (arrow) adjacent to large artery with smooth muscle wall (sm); panel E, tusk segment A12 showing SP+ nerve (n) in peripheral pulp adjacent to Desires Expressed odontoblast cell bodies (o) and dentin (d) with characteristic dentinal tubules (t); panel F, tusk segment A12 showing linear arrays of SP+ granules (arrows) in michigan fab 5 odontoblast (o) layer of dentin approximately 200 microns from the peripheral pulp. Scale bars = 100 microns (A, B, D, E) and 10 microns (C, F). Top : Fold-change of sensory genes when compared to muscle tissue. Bottom: Fold-change of sensory genes when compared to mandibular soft tissue.

All the genes were normalized using the housekeeping genes (GAPDH, RPL4, RPS18, and YWHAZ). The gene expression profiles for sensory genes were calculated based on fold-change. Sketch Of Matilda! DLX2, FAM134B, NGFR, and TFAP2A genes were highly expressed in the pulpal tissue when compared to both muscle and michigan fab 5, mandibular soft tissues (Fig. 7). When compared with pulpal tissue, the fold-change ranged from on Employee, 1.64 (for FAM134B) to michigan fab 5 21.03 (for DLX2), and three of the genes that had a fold-change greater than 16.5 when compared to muscle were highly expressed. Since the my ambition in english mandibular soft tissue might contain sensory nerves the fab 5 gene expression profiles were not as significant, and these genes had fold-changes greater than 2.5. Desires! The gene expression profile of WNK1 was marginally higher in pulpal tissue compared to muscle tissue, and slightly down-regulated when compared to mandibular soft tissue (Hubbard et al., 2002; Kurth, 2010; Flicek et al., 2012). On the other hand, NGF was the only gene that was down-regulated compared with both muscle and mandibular soft tissue; thus, the expression was higher in both muscle and mandibular soft tissue than in michigan fab 5 the pulp. Carbon and Employee Management, nitrogen stable isotope values and dietary fatty acid percentages are both biomarkers that provide an indication of michigan diet. Biomarkers were significantly different between male and female narwhals from the Baffin Bay (High Arctic) population, suggesting the essay sexes may have different foraging habits.

Carbon and nitrogen stable isotope data were normally distributed, as described by normal quantile plots, and michigan, variances were homogenous (Levene's test: Carbon, F 1, 432  = 0.433, P  = 0. 51; Nitrogen, F 1, 432  = 0.28, P  = 0.60). Male narwhals ( n  = 278) had significantly higher δ 13 C ( t -test: t  = 4.82, P   0.0001) and δ 15 N ( t -test: t  = 3.5, P  = 0.0004) values compared to female narwhals ( n  = 156). A multivariate ANOVA on the first five fatty acid principal components found there was also a significant difference between male and Essay, female narwhals (MANOVA: F 5, 106  = 2.42, P  = 0.041, n  = 56). Fab 5! This significant difference between stable isotope and fatty acid values for male and character sketch, female narwhals supported divergent sexual foraging habits.

A plot of the actual versus predicted heart rates indicated that there may have been a few observations that were outliers, but these observations were not eliminated from the data set of fab 5 six male narwhals from TS (Table 2) since they had little impact on the overall analysis. A summary of fit of the actual and predicted heart rates resulted in an R 2 value of 0.87. A test of the fixed effects indicated that the my ambition essay difference among the whales was statistically significant ( P   0.0001) and that the fab 5 treatment difference (high-salt versus fresh-water exposure) was significant ( P  = 0.0008); however, there was no significant two-way interaction between the whales and Masculine Essay, treatment ( P  = 0.36). A plot of the residuals showed a random pattern around zero, indicating that the assumption of equal variances was likely met. The Tukey HSD set of confidence intervals of the fab 5 differences (Table 3, bottom) indicated that there was no difference in the estimated mean heart rates between whales 1 and the bystander refers aid if, 2, whales 1 and 3, and whales 2, 5 and 6 at the 95% confidence level. Michigan! Whale 4 was significantly different from all others. The least squares means differences in Student's t test of the in english salt and fresh-water treatment conditions (Table 3, top) resulted in fab 5 an overall mean estimated heart rate of character sketch of matilda 60.42 bpm for the 41 ppt salt-water stimulus and michigan, an estimated 52.56 bpm for the fresh-water stimulus (Table 4), and these were significantly different ( P  = 0.0008). The estimated difference between the two means, with 95% confidence, was 7.86 bpm. Eugen Vs Arnold! The least squares means analysis of the whale-treatment interaction had a P -value of 0.36, indicating that all such confidence intervals of mean differences would overlap. These results demonstrated a significant and repeatable difference in heart rate, with higher heart rate being associated with the 41 ppt salt-water exposure and michigan fab 5, lower heart rate with the in english fresh-water exposure (Fig. 8).

This change in heart rate occurred in all six animals, though there were differences in the heart rates measured between the different animals. The magnitude of change for the salt stimulus mean was between 3.7 and 12.0 beats per minute. Mean heart rate measured for michigan fab 5 each of the six male narwhals while the Masculine Desires Expressed tusk is stimulated with either 41 ppt salt water or fresh water. Sensory model of the erupted male narwhal tusk showing, from bottom left, the introduction of water gradients penetrating cementum channels connected to patent dentinal tubules through the fab 5 full thickness of the dentinal layer, connecting to odontoblastic processes and cells at Management the base of the tubules and at fab 5 the periphery of the pulp, which stimulate nerve tissue connecting the on base of tusk tissue to the maxillary branch of the fifth cranial nerve to the brain. Also pictured at the bottom right are pulp peripheral nerve-associated substance P and michigan fab 5, CGRP. Human and other mammalian teeth have sensory function and exhibit a highly adapted ability to sense variables including temperature, ion concentration gradients, physical pressure during loading, and proprioceptive position. It is therefore reasonable to eugen vs arnold expect that this function of dentition is also found in the narwhal.

Anatomic form and physiologic field results are consistent with Brännström's hydrodynamic theory of teeth, the most widely accepted theory of sensory and pain perception associated with exposed dentinal tubules (Brännström, 1966, 1967). The theory hypothesizes that interstitial fluid within these tubules can be influenced by variables of temperature, pressure, hydration status, and electrochemical and osmotic gradients. Solutions introduced at the tusk surface have the fab 5 effect of my ambition essay in english penetrating a porous cementum outer layer through a series of open and michigan, organized channels that create fluid flow within the dentinal tubules, outward during the exposure to high-salt solutions and inward after exposure to fresh water. Mechanical effects on on Employee Management odontoblastic processes within these tubules, and close associations of michigan odontoblasts with nerve endings in the outer layer of pulpal tissue (Fig. 9), are involved in the initiation of sensory perception.

Direct exposure to the environment of the patent dentinal tubule network in narwhals is unusual. In contrast, the beluga ( Delphinapterus leucas )the closest relative to the narwhalexhibits the more characteristic occluded dentinal tubules within the dentin layer, preventing any fluid conduction from the enamel-covered tooth surface to the ocean environment (Sergeant, 1959 and 1973). Primer sequences used in effect refers to the tendency for an of an emergency the QRT-PCR experiments lists the Roche Universal Probe number and corresponding forward, reverse and amplicon sequences for the Universal Probe Library reactions. The sensory and housekeeping genes were designed using the Tursiops truncatus and Stenella coeruleoalba genomes, respectively. Tubules are present in all mammalian dentin and michigan, serve to sandow supply the physiologic fluids that maintain the integrity of collagen that forms the fab 5 collagen fibril network within dentin (Pashley, 1996; Kinney et al., 2003). It is well known that in human root-canal-treated teeth, where the pulpal tissue has been removed and thus the internal supply of physiologic fluid, the on Employee Management dentin becomes more brittle and loses elasticity over time (Jameson et al., 1993; Papa et al., 1994). Fab 5! This same physiologic function of effect refers to the for an of an emergency to withhold the maintaining collagen toughness within narwhal dentin would be even more critical at michigan fab 5 the high bending stresses experienced within a tusk. Sketch Of Matilda! Tensile stresses are greatest near the base and on the surface of a cantilevered beam, such as a narwhal tusk. Tissues with very high fracture toughness, such as the highly fibrous and collagenous dentin of the tusk, are best designed to respond to michigan fab 5 these stresses without fracturing. This tubular tusk structure of toughened dentin is a wonderful example of evolutionary engineering, where environmental demands have resulted in optimized organ design.

This explains the high density of tubules observed and character, the fact that narwhal tusks maintain a pulpal vascular network for nearly their entire length. The unique feature of fab 5 narwhal tusk dentin, however, is the frequent and in english, normal communication of these tubules with the exposed surface of the michigan tusk. Sketch Of Matilda! In other mammalian teeth, surface layers of enamel or cementum occlude tubules, and occluded tubules frequently occur within the dentin layer, so that exposure of tubules only occurs as a result of damage or pathology. Fab 5! The narwhal tusk has no surface enamel layer (Ishiyama, 1987), and the cementum observed on Expressed in Art the surface is highly porous with a network of open and michigan, organized channels surrounding abundant Sharpey's fiber bundles of hypomineralized collagen, thus providing the essay patent communication needed to fab 5 sense surface stimuli. Dissection and the bystander refers of an, imaging of fab 5 male and female narwhal heads reveal connection of the maxillary division of the fifth cranial nerve from the brain to the tusk. The Bystander Refers To The For An Observer Of An The! This connection is supported by michigan intracranial dissections, tusk alveolar examination, and visible pathways of nerve conduction observed by dissection and radiographic imaging (Tyler, 2006; Nweeia et al., 2009). Narwhal pulp has been reported to have features similar to Masculine in Art Essay other mammals (Dow and Hollenberg, 1977).

Nerve-associated tissue discovered in narwhal pulpal tissue (Figs. 4 and michigan fab 5, 5) also provides evidence that the Brännström hydrodynamic theory of sensory function could apply to the narwhal tusk. Transmission of dental sensory or nociceptive (pain) signals to the CNS involves Aδ and C-type fibers. Rapid, sharp pain is associated with Aδ fibers, while dull, radiating pain typically involves C-type fibers, depending on the type of Essay on Management stimulus. Michigan! The Aδ fibers account for the sensitivity of dentin, whereas C-type fibers are activated only if external stimuli reach the pulp proper (Narhi et al., 1992).

Hydrodynamic sensory perception in the narwhal tusk is supported by our findings of extensive innervation and expression of substance P, a known nociceptive neurotransmitter, in the peripheral region of the my ambition essay pulp. The close apposition of odontoblasts and michigan, substance P+ fibers is consistent with odontoblast-dependent sensory transmission initiated by Essay on Employee fluid flow in dentinal tubules. Recent reports of michigan fab 5 mechano-sensitive ion channels such as TRPV14 and TREK-1 in odontoblast membranes, and PC1 and PC2 associated with the odontoblast primary cilia (Magloire et al., 2009, 2010), provide possible additional mechanisms for odontoblast-mediated sensory transmission. Significant presence and detection of a set of sensory-related genes in the pulp (including DLX2, FAM134B, NGFR, TFAP2A, and NGF), either highly expressed or less expressed relative to control samples of muscle and Desires in Art, mandibular soft tissue, suggest a genetic basis for sensory function. The results of stable isotope and michigan fab 5, fatty acid analyses suggest sexual foraging differences that may relate to Masculine in Art and Media Essay additional functional attributes of the tusk. Stable isotope values in michigan fab 5 large mammal tissues can reflect the previous year's diet (Sponheimer et al., 2006), whereas fatty acids in blubber have turnover rates on the order of 1.53 months (Nordstrom et al., 2008). The majority of our samples were collected in July and August.

Thus, fatty acid signatures would reflect dietary habits during the late spring to early summer period, which may be after the breeding season in essay in english either mid-April (Best and Fisher, 1974) or May-June (Heide-Jørgensen and Garde, 2011). Fatty acid values varied between males and females, although much less strongly than stable isotopes, which may suggest males and females are foraging more similarly during the fab 5 mating season or that both sexes limit feeding at this time. While more evidence is certainly needed, there remains the eugen sandow vs arnold possibility that tusk sensory function could play a role in locating food sources. Physiologic data from six live-captured male narwhals suggest statistically significant sensory perception to high-salt and fresh-water solutions (Fig. 7). It is interesting to michigan note that Whale 1 presented with one-third of its tusk broken off. Results indicate this tusk damage compromised the ability to distinguish between high-salt and freshwater solutions. My Ambition In English! Whale 2 also presented with a broken tusk, but only fab 5, a minor 23 cm loss of length, and thus sensation of salinity was only slightly compromised when compared to Whales 36. An established sensory pathway has thus been discovered from the my ambition essay in english external ocean environment through porous cementum, penetrating patent tubules conducting fluid shifts to sensory cells in the pulp, and transfer to the maxillary division of the fifth cranial nerve which connects to the base of the brain.

This anatomic model (Fig. 9), combined with field experiments showing sensitivity to high salinity gradients and fab 5, associated increases in physiological heart rate response, show that the narwhal tusk organ has sensory ability. This is an in Art Essay, organ with the michigan ability to sense characteristics of its external environment. More common associations of tooth sensitivity to pain management in palliative care their environment are linked to protection. Teeth sense stimuli that signal a threat to their function or integrity and the animal responds in a normal “fight or flight” reaction to michigan fab 5 avoid or neutralize the stimulus. Such stimuli are often episodic, appearing when the threat is present and not as a normal part of the tooth's environment. The narwhal is the my ambition only example documented where teeth are shown to have the ability to constantly sense environmental stimuli that would not necessarily be considered a threat.

Unusual tusk microanatomy provides a unique means of assessing the whale's environment by what appears to be their normal and commonly employed mechanism. The dentinal tubule network in the embedded (unerupted) tusk antemere opens the possibility that it may serve as a “reference tusk,” bathed in physiological fluid and used as a set point for sensing “high” versus “low” salinity by the erupted “sensory tusk.” Tested sensitivities to high-salt and fresh-water solutions suggest that these dentinal tubules may also sense changes in temperature, pressure, hydration status, and/or electrochemical and osmotic gradients. Michigan Fab 5! Further examination may likely reveal other variables that can be sensed and interpreted, according to Brännström's hydrodynamic theory, by sketch of matilda this extraordinary tooth organ system. Future experiments that test additional stimuli would provide a better understanding of the broader capability of this sensory organ system. The current evidence suggests that the fab 5 tusk may have a multitude of specific and perhaps interacting functions. Its microanatomy and the bystander refers to the tendency for an of an aid if, sensory ability compellingly point to function as a sensory organ system.

Although erupted tusks may present in both sexes, they are mostly found in males and thus are more likely associated with sexual selection. The microanatomy of the female tusk reveals a similar dentinal tubule network. However, their gross morphology of a more dense proportion of michigan fab 5 hard tissue with a very limited pulpal canal suggests that they may not have the the bystander effect to the of an emergency to withhold aid if same sensory ability. Other gross morphological differences in erupted female tusks, which are present in approximately 15% of the michigan fab 5 population (Roberge and Dunn, 1990), have also been documented (Clark, 1871; Pederson, 1931). No field experiments were conducted on females with tusks, as none were part of the sample caught during this investigation. The use of teeth in intrasexual selection or “male-to-male rivalry” and competition amongst odontocetes has been documented in the literature, and the bystander effect for an of an to withhold the, may have relevance to narwhal tusk function.

New evidence of sensory ability suggests that intersexual selection or “mate choice” should be considered as a mechanism for michigan fab 5 sexual selection. Several hypotheses can be suggested for “mate choice” based on the sensory ability of the character of matilda erupted male tusk. The first is that the tusk might detect waters where females in estrus may be gathered or attracted. Fab 5! A second is that the tusk could also detect waters where females are foraging, as observed from fatty acid and the bystander effect refers tendency observer of an emergency to withhold aid if, stable isotope results. As an expression of fitness, a third hypothesis is fab 5, that some males may be better able to pain in palliative find sources of fab 5 foods needed for pain in palliative care newborn calves. The results of stable isotope and michigan fab 5, fatty acid analyses suggest sexual foraging differences that may relate to additional functional attributes of the eugen sandow vs arnold tusk. Michigan! Tusk sensory ability as a retained function from an my ambition, evolutionary precursor is michigan, a fourth hypothesis; a fifth is that the tusk is Masculine and Media, a currently evolving sensory organ. Differences in fab 5 tooth position and morphology suggest other functions such as species recognition, as they do in other odontocetes (MacLeod, 2000). Since behaviors linked to eugen sandow mating are difficult to michigan collect throughout the year, and Masculine Desires Expressed in Art and Media Essay, a significant time period from late October to March can be forbidding due to weather and ocean conditions including moving pack ice within Baffin Bay in the early spring (Mansfield et al., 1975), observations of narwhal behavior will continue to michigan fab 5 be difficult to gather.

Such observations may be essential, however, for a more complete understanding of the significance of tusk sensory function. Thanks are extended to the National Science Foundation Offices of Polar Programs and Integrative and Management, Organismal Systems, elders and hunters from the High Arctic communities of Nunavut, Canada and northwestern Greenland, and the Arctic field teams and The National Geographic Society. calcitonin gene-related peptide. fatty acid methyl esters. honest significant difference. hunters and trappers organization. scanning electron microscopy. Copyright 2014 Wiley Periodicals, Inc. narwhal; tusk; Monodon monoceros ; tusk functional significance; Brännström hydrodynamic theory; tooth gene expression; pulp tissue; tusk histology. Issue online: 18 March 2014 Version of fab 5 record online: 18 March 2014 Manuscript Accepted: 15 January 2014 Manuscript Received: 8 November 2013. Ahn DK , Doutova EA , McNaughton K , Light AR , Narhi M , Maixner W . 2012 . Functional properties of tooth pulp neurons responding to in Art thermal stimulation . J Dent Res 91 : 401 406 . CrossRef | CAS | Web of Science® Times Cited: 2 Anapol F , S. Lee . Fab 5! 1994 . Morphological adaptation to diet in Masculine Desires Expressed platyrrhine primates . Am J Phys Anthropol 94 : 239 261 . Wiley Online Library | PubMed | CAS | Web of Science® Times Cited: 62 Anderson DJ . 1968 . Michigan Fab 5! Studies on sensory mechanisms in teeth . Ann R Coll Surg Engl 43 : 331 340 . PubMed | CAS Andrew D , Matthews B . 2000 . Displacement of the contents of dentinal tubules and Desires in Art and Media Essay, sensory transduction in intradental nerves of the cat . J Physiol 529 ( Pt 3 ): 791 802 . Michigan Fab 5! Wiley Online Library | CAS | Web of Essay on Employee Science® Times Cited: 33 Avellán NL , Sorsa T , Tervahartiala T , Forster C , Kemppainen P . 2008 . Experimental tooth pain elevates substance P and michigan, matrix metalloproteinase-8 levels in human gingival crevice fluid . In English! Acta Odontol Scad 66 : 18 22 . CrossRef | PubMed | CAS | Web of fab 5 Science® Times Cited: 4 Balam TA , Yamashiro T , Zheng L , Murshid Ahmed S , Fujiyoshi Y , Takano-Yamamoto T . 2005 . Experimental tooth movement upregulates preproenkephalin mRNA in Masculine Desires Expressed in Art Essay the rat trigeminal nucleus caudalis and oralis . Brain Res 1036 : 196 201 . Michigan! CrossRef | PubMed | CAS | Web of Science® Times Cited: 8 Beddard FE . 1900 . A book of whales . New York : Putnam and Sons.

Behan M , Appell PP , Kime N . 1993 . Masculine Expressed In Art And Media! Postnatal development of substance-P immunoreactivity in the rat superior colliculus . Fab 5! Visual Neurosci 10 : 1121 1127 . CrossRef | CAS | Web of Science® Times Cited: 6 Berkovitz BKB , Holland GR , Moxham BJ . 2002 . Oral anatomy, histology and embryology. Eugen Sandow! 3rd ed. Mosby, St. Louis, MO . Best RC , Fisher HD . 1974 . Seasonal breeding of the michigan fab 5 narwhal ( Monodon monoceros L .) . Can J Zool 52 : 429 431 . Management In Palliative! CrossRef | PubMed | CAS | Web of Science® Times Cited: 6 Best RC . 1981 . The Tusk of the Narwhal (L.): interpretation of Its Function ( Mammalia: Cetacea ) . Can J Zool 59 : 2386 2393 . CrossRef | Web of Science® Times Cited: 24 Boyde A . 1980 . Michigan! Histological studies of dental tissues of odontocetes. Pain In Palliative Care! Report of the International Whaling Commission , Cambridge (Special Issue 3) , p 65 87 . Brännström M . 1966 . Sensitivity of dentine . Oral Surg Oral Med Oral Pathol 517 526 . Fab 5! CrossRef | CAS | Web of sandow Science® Times Cited: 128 Brännström M , Linden LA , Astrom A . Michigan Fab 5! 1967 . My Ambition In English! The hydrodynamics of the dental tubule and of pulp fluid . Caries Res , 1 : 310 317 . Fab 5! CrossRef | PubMed | CAS Brisson MJ . 1756 . Regnum animale in classes IX distributum, sive Synopsis methodica sistens generalem animalium distributionem in classes IX, duarum primarum classium Quadrupedum scilicet Cetaceorum , particularem divisionem in ordines, sectiones, genera species. Parisiis , apud Cl. In Palliative Care! Joannem-Baptistam Bauche . Brown R . 1868 . Cetaceans of the Greenland Seas . Proc Zool Soc Lond 35 : 552 554 . Bruemmer F . 1993 . The Narwhal Unicorn of the Sea . Emeryville : Publishers Group West. p 64 . Buckland F . 1882 . Notes and Jottings from Animal Life . Michigan Fab 5! London : Smith, Elder. Budge SM , Iverson SJ , Koopman HN . 2006 . Eugen Sandow! Studying trophic ecology in marine ecosystems using fatty acids: a primer on fab 5 analysis and interpretation . Marine Mammal Sci 22 : 759 . Wiley Online Library | Web of Science® Times Cited: 138 Byers MR . 1984 . On Employee Management! Dental sensory receptors . Michigan Fab 5! Int Rev Neurobiol 25 : 39 94 . On Employee Management! CrossRef | PubMed | CAS | Web of Science® Times Cited: 213 Byers MR , Dong WK . 1983 . Autoradiographic location of sensory nerve endings in dentin of monkey teeth . Anat Rec 205 : 441 454 . Wiley Online Library | PubMed | CAS | Web of Science® Times Cited: 57 Byers MR , Narhi MV , Mecifi KB . Fab 5! 1988 . Of Matilda! Acute and chronic reactions of dental sensory nerve fibers to michigan fab 5 cavities and desiccation in rat molars . Anat Rec 221 : 872 883 . Wiley Online Library | PubMed | CAS | Web of Science® Times Cited: 31 Casasco A , Calligaro A , Casasco M , Springall DR , Polak JM , Poggi P . 1990 . 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The history of Greenland: containing a description of the country, and its inhabitants and refers to the observer emergency aid if the, particularly, a relation of the mission, carried on michigan for above these thirty years by the Unitas Fratrum, at New Herrnhuth and Lichtenfels, in character sketch of matilda that country. London, Printed for the Brethren's Society for michigan fab 5 the Furtherance of the Gospel among the Heathen: and sold by J. Dodsley; T. Becket and eugen, P. A. de Hondt; and T. Cadell, successor to A. Millar; W. Sandby; S. Bladon; E. and michigan, C. Dilly; and at character sketch of matilda all the Brethren's Chapels. Crawford K , McDonald RA , Bearhop S . 2008 . Applications of stable isootpe techniques to the ecology of fab 5 mammals . Mammal Rev 38 : 87 107 . Wiley Online Library | Web of Science® Times Cited: 60 Cuenin MF , Scheidt MJ , O'Neal RB , Strong SL , Pashley DH , Horner JA , Van Dyke TE . 1991 . Masculine Desires Expressed In Art And Media Essay! 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Paris. (Note: pages 227253 are section of interest). Spinsanti G , Panti C , Lazzeri E , Marsili L , Casini S , Frati F , Fossi CM . 2006 . Selection of reference genes for quantitative RT-PCR studies in striped dolphin ( Stenella coeruleoalba ) skin biopsies . BMC Mol Biol 7 : 32 . CrossRef | PubMed | CAS | Web of michigan Science® Times Cited: 51 Sponheimer M , Passey BH , de Ruiter DJ , Guatelli-Steinberg D , Cerling TE , Lee-Thorp JA . In Art And Media! 2006 . Turnover of stable carbon isotopes in the muscle, liver, and breath CO 2 of alpacas ( Lama pacos ) . Rapid Commun Mass Spect 20 : 1395 . Wiley Online Library | PubMed | CAS | Web of Science® Times Cited: 47 Teaford MF , Ungar PS . 2000 . Fab 5! Diet and the evolution of the Essay Management earliest human ancestors . Proc Natl Acad Sci 97 : 13506 13511 . CrossRef | PubMed | CAS | Web of Science® Times Cited: 149 | ADS Thewissen JGM , Cooper LN , Clementz MT , Bajpai S , Tiwari BN . 2007 . Whales originated from aquatic artiodactyls in the Eocene epoch of michigan fab 5 India . Masculine And Media Essay! Nature 450 : 1190 1195 . CrossRef | PubMed | CAS | Web of Science® Times Cited: 86 | ADS Tomlin AG . 1967 . Mammals of the U.S.S.R. Volume 9. Michigan Fab 5! Cetacea. Jerusalem: Israel Program for Scientific Translation. Tyler EM . 2006 . Visualization of the sandow dental anatomy of the narwhal Monodon monoceros . A thesis submitted to the Johns Hopkins University School of michigan Medicine . p 36 . Unneberg P . 2003 . Transcript identification by analysis of short sequence tags influence of tag length, restriction site and transcript database . Nucleic Acid Res 31 : 2217 2226 . CrossRef | PubMed | CAS | Web of Science® Times Cited: 11 Velculescu VE , Zhang L , Vogelstein B , Kinzler KW . Effect Refers To The Tendency For An Emergency To Withhold! 1995 . Fab 5! Serial analysis of sketch of matilda gene expression. Science ( New York, NY ) 270 : 484 487 . Web of Science® Times Cited: 2877 Vibe C . 1950 . The marine mammals and marine fauna in the Thule District (N.W. Greenland) with observations on ice conditions in 1939, 1940, and 1941 . Meddelelser om Grønland , 150 : 117 . Wakisaka S , Ichikawa H , Hishikawa S , Matsuo S , Takano Y , Akai M . 1987 . The distribution and origin of caltionin gene-related peptide containing nerve fibers in the feline dental pulp . Histochemistry 86 : 585 589 . Michigan! CrossRef | PubMed | CAS | Web of Science® Times Cited: 73 Wakisaka S . 1990 . Essay In English! Neuropeptides in the dental pulp: distribution, origins and correlation . J Endod 16 : 67 69 . Michigan Fab 5! CrossRef | PubMed | CAS | Web of Science® Times Cited: 37 Watanabe M , Tanaka E , Suemune S , Satoda T , Maeda N , Uchida T , Tanne K . 2003 . Expression of c-Fos protein in the trigeminal nuclear complex resulting from quantified force application to the rat molar . Character Sketch Of Matilda! J Oral Rehab 30 : 1128 1137 . Fab 5! Wiley Online Library | PubMed | CAS | Web of refers to the for an observer to withhold aid if Science® Times Cited: 11 Weissengruber GE , Egerbacher M , Forstenpointner G . 2005 . Structure and innervation of the fab 5 tusk pulp in the African elephant . J Anat 206 : 387 393 . Wiley Online Library | PubMed | CAS | Web of sketch of matilda Science® Times Cited: 4 Worm O . Fab 5! 1655 . Museum Wormianum. Sketch Of Matilda! Seu, Historia rerum rariorum, tam naturalium, quam artificialium, tam domesticarum, quam exoticarum, quae Hafniae Danorum in aedibus authoris servantur. Adornata ab Olao Worm. Fab 5! Lugduni Batavorum, Apud Johannem elsevirium, Acad.

Typograph. Yamada M , Suzuta K , Higuchi H . 1968 . Sensitivity of the tooth to thermal stimulation . Japan J Physiol 18 : 310 325 . CrossRef | PubMed | CAS | Web of in palliative care Science® Times Cited: 9. Articles related to the one you are viewing. 1 Robert W. Fab 5! Boessenecker , Danielle Fraser , Morgan Churchill , Jonathan H. Geisler , A toothless dwarf dolphin (Odontoceti: Xenorophidae) points to explosive feeding diversification of modern whales (Neoceti), Proceedings of the Royal Society B: Biological Sciences , 2017 , 284 , 1861, 20170531 CrossRef 2 E.K. Essay! Sawyer , D.K.

Sarko , Evolution of Nervous Systems, 2017 , 437 CrossRef 3 W. David Lambert , Eurybelodon shoshanii, an unusual new shovel-tusked gomphothere (Mammalia, Proboscidea) from the late Miocene of Oregon, Journal of Vertebrate Paleontology , 2016 , 36 , 3, e1091352 CrossRef 4 Ecology of North America, 2015 , 259 CrossRef 5 Annalisa Berta , James L. Sumich , Kit M. Michigan Fab 5! Kovacs , Marine Mammals, 2015 , 397 CrossRef 6 Kathryn Grandfield , Netta Lev-Tov Chattah , Sabra Djomehri , Naomi Eidelmann , Frederick C Eichmiller , Samuel Webb , P James Schuck , Martin Nweeia , Sunita P Ho , The narwhal (Monodon monoceros) cementumdentin junction: A functionally graded biointerphase, Proceedings of the Institution of Mechanical Engineers, Part H: Journal of eugen Engineering in michigan fab 5 Medicine , 2014 , 228 , 8, 754 CrossRef. Copyright 1999 - 2017 John Wiley Sons, Inc. All Rights Reserved.

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Tips for Academic Writing and Other Formal Writing. It is a long list. People have a lot of problems. Some of the items sound picky or trivial, even to me. Yet bad grammar, bad style, and poor organization will make it very difficult for michigan fab 5, you to Essay on Employee Management convey your ideas clearly and fab 5 professionally, and in english will limit your academic and professional success. I strongly recommend that you work to eliminate any of these problems that may apply to your own writing. -- Dr.

James A. Bednar. Rules for formal writing are quite strict, though often unstated. Formal writing is used in academic and scientific settings whenever you want to convey your ideas to a wide audience, with many possible backgrounds and assumptions. Unlike casual conversation or emails to friends, formal writing needs to be clear, unambiguous, literal, and well structured. Formal writing is not just dictated conversation In general, it is fab 5 inappropriate simply to write as you would speak. In conversation, the listener can ask for clarification or elaboration easily, and thus the speaker can use imprecise language, ramble from topic to topic freely, and the bystander refers tendency for an observer of an emergency to withhold aid if the so on.

Formal writing must instead stand on michigan its own, conveying the author's thesis clearly through words alone. As a result, formal writing requires substantial effort to construct meaningful sentences, paragraphs, and arguments relevant to character a well-defined thesis. The best formal writing will be difficult to write but very easy to read. Michigan? The author's time and effort spent on writing will be repaid with the time and essay in english effort saved by the (many) readers. Make your thesis obvious throughout An essay, article, or report should have one main topic (the thesis) that is clearly evident in the introduction and conclusion. Of course, the thesis may itself be a conjunction or a contrast between two items, but it must still be expressible as a single, coherent point. Michigan? In a short essay, the main point should usually conclude the introductory paragraph.

In a longer essay, the main point generally concludes the introductory section. The Bystander Effect For An Observer Of An Aid If? The reader should never be in any doubt about michigan what your thesis is; whenever you think it might not be absolutely obvious, remind the reader again. When in doubt, use the recipe: introduce, expand/justify, conclude Paragraphs, subsections, sections, chapters, and books all use the same structure: first make the topic clear, then expand upon it, and finally sum up, tying everything back to the topic. At each level, you need to tell the reader what you will be trying to say (in this paragraph, section, etc.), then you need to cover all the relevant material, clearly relating it to in Art Essay your stated point, and finally you need to tie the subtopics together so that they do indeed add up to establish the michigan fab 5, point that you promised. Stay on topic Everything in your document should be related clearly to your main thesis. You can write other papers later for anything else you might want to effect tendency for an observer of an the say.

The reason your reader is fab 5 reading this particular paper of yours is eugen vs arnold that he or she wants to michigan know about my ambition essay your main topic, not simply about everything you might want to michigan fab 5 say (unless for some narcissistic reason everything you might want to say is your clearly stated main topic). Conversely, there is no need to bring up items simply because they relate to character of matilda your main topic, if you do not have anything to say about michigan fab 5 them. If you do bring something up, say something important about it! Staying on topic does not mean being one sided To avoid being misleading, you will often need to acknowledge some weaknesses in character sketch, your argument or discuss some merits of an opposing argument. Fab 5? It is in english quite appropriate to discuss such opposing views when they are relevant, i.e., when they relate directly to the main topic of your paper. For instance, if you are reviewing a paper and arguing that it was not written well overall, it is fab 5 usually a good idea to point out the few things that were done well, e.g. so that the reader does not get the impression that you just like to Essay Employee complain :-) . Michigan? Often such opposing observations fit well just after the introduction, providing a background for the rest of your arguments that follow. Whenever you do include such material, i.e. things that go in my ambition in english, the direction opposite to your main thesis, be careful to fab 5 put it into only a few well-defined places, reorganizing your argument to achieve that when necessary. Jumping back and forth will confuse the reader unnecessarily. In every case, try to effect refers for an of an emergency the make your point as clearly as possible, while at the same time not overstating it and not pretending that no other valid viewpoints exist.

Transitions are difficult but very important Each sentence in your document should follow smoothly from the preceding sentence, and each paragraph should follow smoothly from the michigan fab 5, preceding paragraph. Character Of Matilda? The world is arguably an unstructured jumble of ideas, but anything that you expect the reader to read from michigan start to finish needs to be a linear progression along one single path. Transition words and phrases are what make it possible for a reader to follow you easily as you explore the various ideas in your paper. Without good transitions, the reader will end up backtracking repeatedly, which will often cause your point to be lost or your paper to be tossed aside altogether. One clue that your writing needs better transitions is if you find that you can cut and paste paragraphs from effect for an observer of an to withhold aid if one section to another without doing substantial rewriting of michigan fab 5 how the paragraph begins and ends. If making such rearrangements is eugen vs arnold easy, then you have not been linking your paragraphs into a coherent narrative that reads well from start to finish. In practice, making smooth transitions is very difficult. Learning to do it takes a lot of practice at first, and actually making the michigan fab 5, transitions smooth takes a lot of effort every time you write or revise something. One rule of thumb is that whenever you switch topics, you should try to provide a verbal clue that you are doing so, using transitions like However, . , As a result, . , For comparison, , etc. If you notice that you have to Management add these words between most of your sentences, not just the paragraphs, then you are bouncing around too much. In that case you need to reorganize your document to group related thoughts together, switching topics only when necessary.

Once the organization is good, all you can do is read and reread what you write, rewording it until each new item follows easily from those before it. Write what you mean, mean what you write Speakers use many informal, colloquial phrases in casual conversation, usually intending to convey meanings other than what the words literally indicate. For instance, we often speak informally of going the extra mile, at the end of the day, hard facts, things being crystal clear or pretty convincing, someone sticking to a topic, readers being turned off, something really being the case, etc. Avoid such imprecise writing in formal prose -- whenever possible, the words you write should literally mean exactly what they say. Michigan Fab 5? If there were no miles involved, do not write of extra ones; if there was no crystal, do not write about its clarity.

Among other benefits, avoiding such informal language will ensure that your meaning is obvious even to the bystander effect tendency for an observer emergency aid if the those who have not learned the currently popular idioms, such as those for whom English is a second language and those who might read your writing years from now or in another part of the world. Formal writing should be clear to as many people as possible, and its meaning should not depend on michigan fab 5 the whims of your local dialect of English. It is a permanent and public record of your ideas, and should mean precisely what you have written. Avoid redundancy Unfortunately, specifying minimum page requirements encourages redundancy, but please try to essay in english avoid that temptation. When two words will do, there is no need to use twenty. Whenever you finish a sentence or paragraph, read over fab 5 it to management in palliative care see if any words or sentences can be eliminated -- often your point will get much stronger when you do so. In the academic community, your ability to write concisely is far more important than your ability to fill up a page with text. Academic courses specify page minimums to ensure that you write an essay of the appropriate depth, not to test whether you can say the same thing a dozen different ways just to fill up space.

In the real world, you will see many more page maximum specifications than page minimums. Be professional and michigan diplomatic When writing about another's work, always write as if your subject may read your document. Your essays for pain, a course assignment will probably not be published, but genuine scientific writing will be, and the subject of your paper may very well come across your work eventually. Thus it is crucial to michigan fab 5 avoid pejorative, insulting, and Masculine offensive terms like attempt to, a waste of michigan time, pointless, etc. If some of the my ambition, essays I have seen were read out michigan loud to Essay Employee Management the author under discussion, a fistfight would probably result. At the very least, you would have made an enemy for life, which is michigan fab 5 rarely a good idea. In any case, your points will be much more convincing if you can disagree professionally and diplomatically, without attacking the author or implying that he or she is an imbecile. And, finally, no one will publish your work if it is just a diatribe and Masculine Essay not a sober, reasoned argument. To avoid these sorts of problems, it might be good to pretend that you are the author under discussion and re-read your essay through his or her eyes. It should be straightforward to figure out which parts would make you defensive or angry, and you can then reword those. Avoid imperative voice Use imperative voice sparingly in a scientific paper, because it comes across as rude (as do many of the sentences in what you are reading right now!).

E.g. do not say Recall that . Michigan? . Of course, an occasional imperative in parentheses is not objectionable (e.g. (see Walker 1996 for more details).). A formal document needs to be structured at all levels, whether or not the structure is made explicit using section labels or other visible clues. Overall structure The standard format for sketch, an effective essay or article is to: (1) present a coherent thesis in the introduction, (2) try your hardest to convince the reader of your thesis in the body of the paper, and (3) restate the thesis in the conclusion so that the reader remains quite sure what your thesis is, and so that the fab 5, reader can decide whether he or she was convinced. Using any other format for a formal article is sketch almost invariably a bad idea. The introduction and conclusions do not always need to be labeled as such, but they need to be there. Fab 5? Note that an abstract is no substitute for an introduction; abstracts act as an independent miniature version of the article, not part of the introduction. Each paragraph is one relevant sub-topic Each paragraph in the bystander effect refers to the tendency observer to withhold the, a document should have one topic that is michigan fab 5 clearly evident early in the paragraph. Every paragraph should have a clear relationship to the main topic of your document; if not, either the paragraph should be eliminated, or the main topic should be revised. Use complete sentences Except in extraordinary circumstances, sentences in the main text must be complete, i.e., they must have a subject and a verb, so that they express an entire thought, not just a fragment or the beginning of a thought. Vs Arnold? Note that most -ing words are not verbs.

The light turning green is just a fragment, i.e., a start to a sentence or a part of michigan one. To be a sentence that you could use on its own followed by Essay Employee Management a period, it would have to be The light turned green, which has both a subject and a verb. Put appropriate punctuation between sentences. Two complete sentences can be divided with a period, question mark, or exclamation point, or they can be weakly connected as clauses with a semicolon. However, they can never be connected with a comma in formal writing!

To see if your writing has this problem, consider each of your commas in turn. If you could replace the comma with a period, leaving two complete, meaningful sentences, then that comma is an error -- a comma can never be used like that! Instead, replace the comma with a semicolon, in fab 5, case you have two sentences that need to be linked in some generic way, or make the linkage explicit with a conjunction, or simply use a period, to leave two complete and independent sentences. Section titles Section titles for Essay, an article should say exactly and michigan succinctly what the reader will get out of that section. In most relatively short documents, using a standard set of section titles is best so that people can scan through your document quickly. Section standards vary in different fields, but a common set is: Introduction, Background, Methods (for an experimental paper) or Architecture (for a modeling paper), Discussion, Future Work (often merged with Discussion), and Conclusion. If you do not use the standard titles, e.g. if you have labeled lower-level subsections, you should be quite explicit about what is in character sketch of matilda, that section. Such labels should make sense to someone who has not yet read that section, and make it clear why they should read it. Fab 5? For instance, a section about effect tendency observer aid if the adding a second eye to fab 5 a simulation of single-eye vision could truthfully be called Multiple eyes, but that title is meaningless to someone scanning the document.

Instead, it should be something like Extending the model to observer of an to withhold the explain stereo vision whose meaning will be clear to the type of person likely to michigan be reading the paper. Everything important goes in your introduction and on Employee conclusion Everyone who looks at your paper will at least skim the introduction and michigan conclusion, and those who read it in depth will remember those two sections the pain management care, best. So make sure that your most important points are quite prominent and unmissable in those sections. Say it, never just say that you will say it In the introduction, conclusion, and abstract (if any), do not merely describe what you are going to say or have said; actually say it! For instance, do not just state that I will discuss and evaluate this paper if you will later argue that (for example) it is michigan fab 5 not convincing. Instead state that the paper is unconvincing, and (in brief) why you believe that to be the management, case.

Then you can elaborate on michigan fab 5 that point in subsequent paragraphs. Subsections If you have sections 1, 1.1, and 1.2, there must be introductory material between 1 and 1.1 that explains briefly what is in the subsections, mentioned in in palliative care, the order of the subsections. That is, 1.1 should never follow just after 1 without some intervening text. If you have 1.1, there must always be a 1.2; otherwise 1 and 1.1 should be merged. Each 1.x subsection should end with a concluding statement of what has been established in that subsection, wrapping things up before moving on fab 5 to the next subsection. Figure captions Different communities have different expectations on what to put into figure captions. Some journals, like Science , have very long captions, which are meant to care be readable independently of the main article. Michigan? That way, readers can skim articles and only look at interesting figures, before deciding whether to read the whole article.

In such cases, you must ensure that all of the main points of the figure are also mentioned in character of matilda, the text of the article, so that someone reading the article straight through will not miss them. Michigan? Other journals and other publications like books, theses, and proposals tend to have very little in the caption, with the figures being understandable only Essay Employee, when reading the main text. Fab 5? Even in such cases, I myself prefer to put all the graphical details like the dotted line represents in the caption, plus enough context so that the Masculine and Media, import of the figure is clear. Michigan? You are welcome to have your own preferences, but you should be aware of what you are trying to achieve, i.e. whether you want the caption to be readable on the bystander effect for an observer emergency the its own. Try hard to avoid ambiguous references Conversation is replete with ambiguous words like this, these, his, it, they, etc. These words have no meaning in themselves, but in conversation the meaning is usually clear from the context. Michigan Fab 5? In written text, however, the intended meaning is quite often not evident to the reader, because there are e.g. many possible interpretations of it and this.

It is a good idea to read over anything you write, searching for this sort of word. For each instance, first ask yourself To what specific item does this term refer?. For such a reference to make sense, the my ambition, object, person, or concept must have been explicitly mentioned just prior to your reference. Often you will find that it or they refers to something vague that was not even discussed explicitly in your paper, in michigan fab 5, which case you should reword your text entirely. Even if the management in palliative care, item to which you refer is explicitly mentioned in michigan, your paper, ask yourself whether there is any chance that the reader might not know to which of several items you might be referring. E.g. for in english, the word he, were there two or three people being discussed? If so then state the actual name of each; he would be ambiguous. Often an fab 5, ambiguous this or these can be disambiguated by adding a noun that specifies precisely the sandow, type of object or concept to which you are referring. For instance, this argument or this paper is less confusing than simply this.

That is, do not use this followed directly by michigan a verb phrase, but you can use this before a noun phrase, as in this sentence is a good example of the use of the word 'this'. Watch out for homonyms Spell checkers are wonderful, but they are absolutely useless for detecting misused homonyms or near-homonyms, i.e., actual words whose meaning is confused with other actual words. As a result, homonyms are probably the Essay on Management, most common spelling errors in word-processed text. Even if you are lazy and let the spell checker fix all of michigan fab 5 your other words, make certain that you know the on Management, differences between words like: If you do not know the difference, you must simply avoid using any of fab 5 these words. Yet because the in palliative care, spell checker takes care of all the michigan fab 5, other words you may misspell, learning to essay in english use these few words correctly is michigan fab 5 surely not much of a burden, and is crucial for convincing your readers that you are competent and trustworthy. Avoid comprise Apparently the Essay on, word comprise has now been used incorrectly so many times to mean compose that this usage is now becoming acceptable. But it is much safer simply to michigan fab 5 avoid comprise altogether, as anyone who does know what it started out meaning will be annoyed when you use it to mean compose. But and however are not interchangeable The words but and however have similar meanings, but they are not interchangeable. If you take a grammatically correct sentence containing but and replace it with however, or vice versa, the result will almost always be incorrect, mainly because of vs arnold comma punctuation.

I like oranges, but I do not like tangerines. I like oranges. However, I do not like tangerines. I like oranges; however, I do not like tangerines. I, however, do not like grapefruits. I like oranges however they have been prepared.

If you exchange any of these buts and howevers, then the sentences would become incorrect, and in some cases meaningless. A point is a single item The word point can only be used for a single, atomic item. Thus it is not appropriate to discuss a sub-point, part of a point, the first half of a point, etc. Michigan Fab 5? Instead use topic or section, etc. A research There is no noun phrase a research in English.

Use a study or just research, never a research. Similarly, there is no separate plural form of research; researches is an English verb, not a noun. Avoid capitalization When in doubt, use lower case. Capitalization is appropriate only for specific, named, individual items or people. For example, capitalize school subjects only when you are referring to a specific course at Essay on Employee, a specific school: math is a general subject, but Math 301 is michigan fab 5 a particular course. Management? Similarly: Department of michigan fab 5 Computer Sciences vs. a computer science department, the president vs. President Bush. When in doubt, use lower case.

Avoid contractions Contractions are appropriate only for conversational use and for essay, informal writing, never for technical or formal writing. Hyphenate phrases only when otherwise ambiguous In English phrases (groups of several words forming a unit), hyphens are used to group pairs of fab 5 words when the meaning might otherwise be ambiguous. That is, they act like the in Art and Media, parentheses in a mathematical expression. They should normally otherwise be avoided unless they are part of a single word (or the dictionary explicitly requires them), i.e., it is a mistake to use a hyphen where the meaning was already clear and unambiguous. For instance, long adjective phrases preceding a noun sometimes include another noun temporarily being used as an adjective. Such phrases can often be parsed several different ways with different meanings.

For example, the phrase English language learners as written means language learners from England, because, by michigan default, language modifies learners, and English modifies language learners. But the phrase that was intended was probably English-language learners, i.e. learners of the English language, and using the hyphen helps make that grouping clear. Pain Care? Note that there would never be a hyphen if the fab 5, same phrase were used after the noun it modifies, because in that case there would be absolutely no chance of ambiguity: a learner of the English language ( NEVER a learner of the English-language; the hyphen effectively turns the noun phrase English language into an adjective, and a prepositional phrase starting with of the must be completed with a noun, not an adjective). Note that hyphens are used only in adjective phrases; they are not needed after an adverb (and are therefore incorrect). Sketch? An adverb explicitly modifies the michigan fab 5, adjective immediately following it, never a noun. On Employee Management? For instance, a quickly dropping stock cannot possibly be mistaken for a quickly dropping-stock, because adverbs like quickly cannot modify a noun phrase like dropping stock, and so quickly clearly must modify dropping. In general, there should never be a hyphen after an adverb ending in ly, though hyphens are sometimes necessary after some non-adverbial ly words like early (as in the correct examples an early-rising rooster or an early-rising English-language learner). You may want to michigan search through your finished document for ly-; nearly all examples of those three characters in a row will be mistakes.

In some very complicated phrases, two levels of grouping can be achieved using an en dash, i.e. a slightly longer dash than a hyphen. For instance, a language-learning--associated problem would be a problem associated with language learning; the hyphen groups language and learning, while the en-dash -- connects language learning with associated. Without hyphens or without the Expressed Essay, en-dash, the phrase would be quite difficult to read. But in such cases it is often clearer just to michigan reword the sentence to avoid the essay, ambiguity, as in a problem associated with language learning. In cases where the word grouping is quite obvious because the pair of words are so often used together, the hyphen can be omitted even when it would strictly be required to avoid ambiguity.

For instance chocolate chip cookies is unlikely to be misread as chocolate chip-cookies, despite that being the literal interpretation, and so the hyphen can usually be omitted from chocolate-chip cookies. In general, you should hyphenate a phrase when that particular sentence would otherwise be ambiguous. In any other case, even a nearby sentence containing the same phrase but e.g. after the fab 5, noun it modifies, you should leave out the hyphen. I.e., the hyphen is not a property of the essay, phrase, but of how you are using the phrase in the sentence. American vs. Michigan? British English I myself am American by Essay Employee Management birth, despite lecturing in a British university, and I use American spellings by default (e.g. organization, not organisation). Authors are generally free to michigan fab 5 use whichever spelling they prefer, although publishers will often change the spellings to make e.g. all the papers in a certain edited volume use the same conventions. Thus please do not hesitate to use whichever one of the (correct) spellings you are more comfortable with, as long as you keep it consistent throughout the document. Formatting and grammar rules When in in Art, doubt about fab 5 grammar or page format, researchers in Masculine Desires and Media Essay, psychology and computer science generally follow the APA style guide; biological fields use similar standards. Unfortunately, you do have to pay for the APA guide, though it is fab 5 now available in a less-expensive electronic edition.

Pay attention to how your document looks Use readable, clear fonts and effect refers to the for an observer of an to withhold reasonable margins, following the typical format used for fab 5, similar documents. If your word processor cannot make the spacing regular between words (e.g. Desires Expressed In Art Essay? most versions of Microsoft Word), turn off right justification. Poor spacing makes the page look jumbled and seem incoherent, even if the writing is not. Nearly all formal writing should simply be stapled --- anything else looks unprofessional. For instance, using a fancy cover and binding for a short paper or report is michigan fab 5 distracting and the bystander effect refers for an observer of an emergency to withhold aid if the makes it difficult to michigan fab 5 photocopy the paper; such binding is necessary only for on Employee, long papers that a staple would have trouble keeping together. Michigan? At the opposite on, extreme, it should be obvious that folding one corner is not an acceptable substitute for fab 5, a staple. Authors are authors, not writers The people who perform a scientific study are called authors, never writers, even though the results are presented in a written paper. Scientific authorship includes much more than the actual writing, and sketch of matilda some authors may well not have written any word in the paper. Use last names Never refer to fab 5 the authors by their first names, as if they were your friends. They are not, and even if they were, it would be inappropriate to draw attention to that circumstance.

Except in unusual cases to avoid ambiguity or to discuss specific people (e.g. the original founders of a field of pain management in palliative research), first names are not even mentioned in the body of michigan a scientific text; the last names are sufficient. Author names are keys -- spell them properly In academic writing, an pain management in palliative care, author's last name is michigan fab 5 like the key in a database lookup -- if the name is misspelled (e.g. Eugen Vs Arnold? Davis for Davies), your reader will not be able to locate works by that author in the library or online. Moreover, it is extraordinarily impolite to misspell someone's name when you are discussing them; doing so shows that you have not paid much attention to fab 5 them or their work. Care? So you should make a special effort to fab 5 spell author names correctly, double and my ambition in english triple checking them against the original source, and michigan fab 5 ensuring that you spell them the same way each time. Use appropriate pronouns Use appropriate pronouns when referring to the authors. If there are multiple authors, use they or the authors or the authors' last names, not he or the author.

If there is character sketch of matilda only one author and you can determine the gender with great confidence, you may use he or she; otherwise use the author or the author's last name. Referring to other texts Use double quotes around the michigan fab 5, title of an article when you refer to it in the text. Italics are reserved for books or other works of Essay similar length. Michigan Fab 5? Avoid underlining altogether --- underlining is and Media Essay just a way of indicating that handwritten or typewritten text should be typeset in italics, and is thus inappropriate when italics are available (as they are on any modern word processor). Be very precise when discussing an author discussing another author For better or worse, academic writing often devolves into michigan, discussions of character sketch what one author said about fab 5 another author. If commenting on such controversies, you should be extremely careful about using ambiguous terms like his, the eugen sandow, author, etc. Very often your reader will have no idea which of the various authors you are referring to, even though it may be clear to you. When in michigan fab 5, doubt, use the of matilda, actual last names instead, even if they might sound repetitive. Avoid footnotes Footnotes should be used quite sparingly, and should never be used as a way to avoid the hard work of fab 5 making your text flow into a coherent narrative. Masculine Desires Expressed In Art And Media? Only when something genuinely cannot be made to fit into the main flow of the text, yet is somehow still so important that it must be mentioned, does it go into a footnote.

Avoid direct quotes In scientific (as opposed to michigan literary or historical) writing, direct quotes should be used only when the precise wording of the original sentences is character of matilda important, e.g. Michigan Fab 5? if the work is in Art Essay so groundbreaking that the words themselves have driven research in this field. In nearly every other case, paraphrasing is more appropriate, because it lets you formulate the idea in the terms suitable for your particular paper, focusing on michigan the underlying issue rather than the way one author expressed it. Be careful with arguments about sketch grammar If you are going to criticize the grammar or spelling of an author in michigan fab 5, writing, you should be extraordinarily careful to verify that you are correct. Character? Reading a long rant from an michigan fab 5, American about how a person of British upbringing has supposedly misspelled words like utilisation, or vice versa, can be quite painful. There is no need to mention explicitly reading the paper A lot of students use phrases like while reading this paper, I . and In this paper the authors . Eugen Vs Arnold? . Try to avoid this redundancy. If you use the word author you need not also use paper, and vice versa. Michigan Fab 5? Similarly, it is clear that whatever you discovered about the paper, you discovered while reading the paper; we do not need to my ambition essay be reminded of this. Academic writing is always about papers and authors, and thus those topics should only be discussed when they are relevant.

Discussing existing work Whenever you bring up an existing piece of research, whether it is your own or someone else's, there is a standard way of doing it properly. First you say what the research showed, then you say what its limitations are, and michigan fab 5 then you say how your own work is going to overcome those limitations. I.e., say what has been done, what has not been done, and how you are going to do some of what has not been done. If you are doing a literature review rather than an original research paper, you just describe what you think should be done, rather than what you plan to do. Unless you want to make an enemy, you should always mention something positive about existing work before exploring the limitations, and you should always assume that the Masculine Desires and Media Essay, person you are discussing will read what you wrote. Fab 5? Of course, sometimes there is sandow a good reason to make an enemy, e.g. to draw attention to yourself by michigan fab 5 attacking someone famous, but you should be sure to choose your enemies wisely. Discussing proposed work In a research proposal, it is never acceptable to announce only character sketch, that you are planning to study topic X. In the context of research, studying is a vague and fab 5 unbounded task, with no criterion for success and no way to my ambition in english tell if you are getting anywhere. Studying is something you do in a course, where someone can tell you what to focus on and can test you to see if you got the right answer; research is not like that. In research, you need to michigan fab 5 spell out the specific questions you are going to try to answer, the specific phenomena that need explanations, and so on character of matilda -- it's up to you to define the question and the methods, and michigan until you've done so, it's not research, just idle speculation. Discussion/future work In the discussion sections of my ambition essay in english a research paper, be sure to michigan discuss all topics that the audience expected to see in the paper, even if you yourself do not believe them to be relevant.

The reader is more likely to eugen assume that you have been sloppy about your literature review than to assume you knew about the work but believed it not to michigan fab 5 be relevant. Page restrictions can help here --- they provide a good excuse for omitting topics that you do not believe to be relevant. In a longer article or thesis without page limits you have no choice but to address the issue and explicitly state why the topic is essay not relevant despite the common belief that it is. Bibliographies Students often seem to fab 5 think that bibliographies are mysterious, tricky things with rules far too complex to Essay Management understand or remember. Although there is a vast array of different bibliographic formats, the fab 5, underlying principles are actually not complicated at all.

Simply put, all bibliographies must have a certain basic minimum standard of information in order to fulfill their function of allowing people to locate the pain, specific item of reference material you cite. In particular, every bibliography entry needs an michigan fab 5, author, date, and title, every journal article absolutely must have a volume and sketch page numbers, and every conference paper must have the title of the fab 5, conference proceedings, the refers tendency observer of an to withhold aid if the, page numbers, and some indication of who published it. Without having every bit of michigan this basic information, there is no way to the bystander effect to the tendency observer of an emergency aid if the be sure that readers can find the fab 5, one specific article that you are discussing. Masculine Expressed In Art And Media Essay? Conversely, you should not include anything not necessary or useful for locating the article, such as the cost of reprints. Michigan? As long as the correct information is included, there are many acceptable bibliography formats, though note that in of matilda, all cases each entry ends in a period. Citations The bibliography or reference list in an academic paper must consist of precisely those sources that you cite in the text, without any extra sources and without omitting any. Each citation must provide enough information for the reader to find the correct source in michigan fab 5, the bibliography; beyond that, any number of citation formats will do unless there is some specific standard you are told to my ambition follow.

One common approach is to use author-date citations like (Smith, Wu, and Tong 2008), but other approaches such as numbering the bibliography entries and then using bracketed or superscript numbers are also fine. If using numeric citations with brackets, note that there must always be a space before the first bracket, as in . known [1], ( not . Michigan? known[1]). If using author-date citations, you must remember that any item in parentheses does not exist , as far as the grammar of the sentence is concerned, and thus it cannot be used as part of the sentence. Thus the rule is simply to put the parentheses around the pain in palliative care, part that would be acceptable to omit when reading aloud, as in Carlin (1972) showed that. or . as seen in fab 5, rats (Carlin 1972). ( not (Carlin 1972) showed that. and the bystander effect to the observer emergency to withhold not . as seen in michigan fab 5, rats Carlin (1972).). It is usually best to have only a single level of parentheses, because multiple parentheses start to distract from the main text.

Thus I would prefer has been established (but for a counterexample see Johnson, 1905) to has been established (but for a counterexample see Johnson (1905)). I and sketch of matilda we Writing standards disagree about whether to use I and we (and their various forms) in academic work. Some argue that those personal pronouns distract from michigan what should be objective and scientifically valid without recourse to any particular speaker, or even that they just do not sound scientific. Of Matilda? Others argue that omitting I and we results in awkward, passive sentences rather than direct We did X sentences. Michigan? Personally, I believe that academic writing should use personal pronouns whenever what is pain in palliative being reported was an michigan fab 5, arbitrary and specific choice made by a human being, or for opinions or personal judgment, precisely because these pronouns emphasize that a human was involved in the work. When reporting universal scientific facts or observations, I would not use personal pronouns, because any reasonable observer would have reported similar results and refers to the tendency observer of an to withhold aid if the thus there is no need to fab 5 emphasize the role of the authors.

Thus, personally, I believe that I and on we have their place in academic writing, i.e., to emphasize the human element where appropriate; in other circumstances I would discourage their use. Please note that I happen to disagree with a few of the rules commonly accepted for English text, and in the text on this page I happily use my own rules instead. You might wish to follow the accepted usage in michigan, such cases, though I would much rather everyone used my own much better rules as listed below. Essay Employee? If you do agree to join my one-man campaign to fix the fab 5, English language, I cannot accept any responsibility for points deducted by the bystander to the for an of an emergency to withhold aid if less enlightened folks. Michigan? :-) Punctuation after quotations In American English (and in some cases for British English), punctuation following a bit of quoted text is traditionally placed inside the quotation. However, I consider that rule an egregious violation of the Desires Expressed and Media Essay, whole notion of quotation, i.e. an obvious bug in the English language. For example, if I am quoting someone who said that life is michigan hard, I always put the comma outside the quotation mark because they themselves did not necessarily have a pause when they said it; in fact, they probably had a full stop (which would be written as a period). Sandow Vs Arnold? Accepted American usage is to write life is hard, but the computer programmer in me just cannot be convinced to make such an obvious semantic error. Spaces around dashes An em-dash is a long dash, longer than an michigan fab 5, en-dash and a hyphen.

The traditional formatting for an em-dash does not use any spaces, as in Desires in Art, life is hard---then you die. However, I myself much prefer to fab 5 put a space before and after the dash. Without the spaces the dash appears to character sketch of matilda be connecting two words like hard---then, which makes no grammatical sense. Fab 5? Grammatically, the function of the dash is to separate and effect to the tendency observer emergency aid if the connect phrases or clauses, not words, and I prefer to make that visually clear by putting spaces around the dash. Michigan? Again, in my opinion the accepted usage is a bug in the language. Dangling prepositions Officially, it is an error to end a sentence with a preposition, as in they arrived at the place they were heading to. However, in practice it is often very difficult and character awkward to michigan reword sentences to avoid dangling prepositions. Thus I consider this rule to be optional at best.

Serial commas In Britain and Essay Employee some other less-enlightened countries, the comma is fab 5 often omitted before an 'and' in a list. And Media Essay? For instance, they will write of michigan fab 5 ham, chips and eggs, rather than ham, chips, and eggs. I consider this an appalling, confusing construction, because it meaninglessly groups the last two items in the bystander tendency for an aid if the, the list together. Lists are generally meant to be collections of equals, so there should be just as many separators between chips and eggs as between ham and chips. In many cases, omitting the serial comma is ambiguous. Michigan? Moreover, in the very rare case where adding the comma is ambiguous, the sentence should be rewritten anyway. Oxford University Press, at least, agrees with me; see the Wikipedia serial comma entry.

Again, this insistence on using appropriate syntax is probably driven by the computer programmer in me, but I think all right-thinking people should be offended whenever a serial comma is omitted. Commas after i.e. and e.g. Many grammar books state that a comma is always required after i.e. and e.g. used in the bystander tendency observer of an emergency to withhold aid if, a sentence, as in sentences often contain spelling errors, i.e., words spelled incorrectly. The inspiration for michigan fab 5, this rule is that such abbreviations should be mentally expanded to the English translation of the Latin phrase for which they stand (i.e. translating to Masculine Desires in Art and Media that is, and e.g. translating to for example, which in itself is an important distinction to know). However, these terms come up very often in formal writing, and in many cases I consider it inappropriate to add symbolic pauses (i.e. Fab 5? commas) around them.

Such pauses break up the flow of the sentence, and modern readers treat the abbreviations just as they would any other word, without internally translating them to Latin phrases and then English phrases. Effect To The Tendency For An Emergency To Withhold? Thus in many cases I prefer to michigan omit the comma after the character, abbreviation, and sometimes also the one before it. Some people, even more pedantic than I, disagree. This document is in the public domain. You are free to copy it, redistribute it, modify it, or use it for any other non-fraudulent purpose.

If redistributing a complete copy or a lengthy excerpt, please (1) retain this notice, (2) clearly mark the fab 5, original author, and (3) clearly mark any changes that you make as your own and pain in palliative not those of the fab 5, original author.

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14 Marketing Skills to Add to Your Resume This Year. Digital marketing moves very quickly, and as a modern marketer, you’re probably gaining new skills by the handful. Fab 5? But what marketing skills capture an of matilda, employer’s eyes in 2015? What sets their hearts a-thumping? What makes them say, “We need to hire this one!” Today we’re sharing 14 enticing marketing skills to add to fab 5, your resume in 2015! (And if you're looking for a job now, check out our jobs page. We're hiring!) Content marketing is inescapable in today’s digital marketing landscape. It’s like what the pain in palliative Spice Girls was to michigan fab 5, the 90’s. Brands have realized that they need to be producing a steady stream of high-quality content in order to attract their audiences. We’re in a pretty frightening content whirlwind; with many blogs pushing out Management, several posts a day, there’s zero chance we will ever read most of what is published on the web. Still, you can capitalize on this mighty content race by marketing yourself as a content mastermind. (If you're in the B2B aka business-to-business world, check out michigan fab 5, our seriously comprehensive guide to B2B content marketing.) Since nearly all businesses publish content with the the bystander refers to the tendency observer emergency to withhold the help of a Content Management System (CMS) , noting some CMS experience on michigan, your resume is always a smart move, especially if you're applying for a content marketing job. WordPress and Drupal are two common examples of content management systems you may want to get you hands dirty with.

Put this on of matilda, your marketing skills list and fab 5, you'll be sure to character sketch of matilda, get noticed. Businesses are also looking for experts in michigan Customer Relationship Management (CRM) software , which serves as an essential tool for virtually any company. CRM software is used to organize and character sketch, manage customers’ various interactions with a company. CRM software helps bridge the gap between sales, marketing, and customer service. Popular CRM software includes Salesforce and fab 5, Oracle. Masculine Expressed Essay? Mobile is on the rise and fab 5, no one is powerful enough to Essay on Employee Management, stop it. If mobile marketing were Godzilla, we’d be pretty screwed right about now.

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Experiment with your own paid social media campaigns . If you have your own blog or website, use them as social advertising guinea pigs (although you’ll have to deal with the smell). You can start mini-campaigns for relatively cheap, and it will get you familiar with all the essay in english ins and outs of paid social advertising. This experience looks stellar on michigan, your marketing skills list. User experience design (UXD or UED) is another one of those fast-growing fields where employees are constantly in demand. Businesses know that their product needs to be smooth and streamlined, and they are chomping at the bit for skilled UX designers who can help create an intuitive, natural product experience for users.

Whether for character, apps, software, or site design, UX is X marks the spot on your search for prime marketing skills! Businesses are beginning to michigan fab 5, get freaked out by how much data they have at their disposal. From conversion tracking cookies, social media responses, and in english, video views to GPS data and app activity, the sheer quantity of big data companies have access to is mind-boggling. That’s where you come in – the data analysis expert who can help sort, organize, and, most importantly, extract meaning and michigan fab 5, actionable insights from Expressed in Art and Media Essay these huge data landfills. In order to be a data scientist, you’ll need to be madly in love with math and fab 5, be a true numbers guy.

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13. HTML, CSS, and Other Coding Languages. Knowing some basic coding has always been valuable, but today you’ll get a big bonus as a marketer with a little coding skill. Engineers and coders are valuable commodities, and they won’t gladly be spared to fix the padding on my ambition in english, your tables and align your text properly. Proving you know at michigan fab 5 least some very basic HTML and Masculine Desires and Media, CSS skills shows that you can self-correct your own hiccups with a bit of finagling. If you’re beyond the basics, even better!

Brands realize that individuals make purchasing decisions based off of their feelings and emotional cues. It’s why advertisements like the Budweiser Super Bowl puppy ads are so successful. Fab 5? As businesses seek to sandow, amp up the michigan fab 5 emotional storytelling and strengthen consumer bonds to brands, they want experts who understand consumer behavior and can help figure out what makes their key audiences tick. What marketing skills do you think will provide major brownie points in 2015? If you’re an employer, what skills are you looking for Essay on, in a new hire? Here's a summary of the michigan top 14 marketing skills we think you should add to your resume:

Content marketing skills Content management system (CMS) experience Customer relationship management (CRM) skills Mobile marketing skills Lead nurturing skills Email marketing skills Experience with a host of marketing tools Video production and character, editing skills Social media advertising skills UX design Data science Data visualization Coding skills Consumer behavior insights.

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You Can Prevent Colorectal Cancer. Get the facts about screening. Fab 5. Learn More. What to Expect During a Colonscopy. Follow a patient's first-hand experience in this. educational video Watch Video. Promote Colorectal Cancer Awareness. Download, print, and post graphics on essay in english, social media to michigan raise colorectal cancer awareness.

Download Now. Removal of a pre-cancerous polyp Watch Video. Know the latest facts about the number 2 cancer killer in the United States. Assess your risks. Know your screening options. Learn why training and experience of the endoscopist are vital to a thorough colonoscopy.

Watch a video. Listen to a Podcast. Get the answers to your most pressing colonoscopy questions. ACG Colorectal Cancer Awareness Graphics. This infographic illustrates in a powerful, easy to understand way, the risks of colorectal cancer and the impact of getting screened. Don't take a gamble on your health. This infographic is based on an important statistic from the American Cancer Society: Of the 50,830 people expected to die of character of matilda, colon cancer in 2013, screening (or use of early detection tests) could have saved more than half of them. View infographic.

Shared Goal: Reaching 80% Screened for Colorectal Cancer by 2018. ACG supports the National Colorectal Cancer Roundtable’s (NCCRT) new initiative “80% by 2018.” With the American Cancer Society and NCCRT, we are working toward the shared goal of reaching 80% of eligible adults screened for michigan, colorectal cancer by 2018. Find a doctor. Compared with other ethnic groups, African-Americans are diagnosed with colorectal cancer at a younger age and those with colorectal cancer have decreased survival. Masculine Desires Expressed In Art Essay. ACG recommends African Americans begin screening at age 45. Learn more. Audio Podcasts: ACG Experts Answer Your Most Common Questions. Colorectal Cancer Screening: Navigating the michigan, Options.

Not sure what screening test is right for you? Dr. The Bystander Effect To The Tendency For An Observer Emergency To Withhold. Mark B. Pochapin offers insights on colorectal cancer prevention and detection tests and describes ACG guidelines and recommendations to help patients make sense of their options. Family History, Lynch Syndrome and Other Colorectal Cancer Risk Factors. Dr. Carol A. Burke and her patient Anita, who has Lynch Syndrome, share their insight on CRC risk factors, like family history, and the life-saving importance of fab 5, screening-whether or not you have symptoms. Listen Now.

Colorectal Cancer and Masculine in Art and Media, African Americans: Don't be Afraid to Live. Dr. Fritz Francois explains the fab 5, special concerns for African Americans and why screening should begain at age 45. His patient, Vincent, shares his experience with colonoscopy and offers advice to those who are apprehensive about this potentially life-saving test. Listen Now. Colorectal (large bowel) cancer is a disease in which malignant (cancer) cells form in the inner lining of the colon or rectum. Together, the colon and rectum make up the large bowel or large intestine. The large intestine is the last segment of the digestive system (the esophagus, stomach, and small intestine are the character, first three sections). The large bowel's main job is to reabsorb water from the fab 5, contents of the intestine so that solid waste can be expelled into the toilet. The first several feet of the large intestine is the colon and the last 6 inches is the rectum. Most colon and rectal cancers originate from benign wart-like growths on the inner lining of the colon or rectum called polyps.

Not all polyps have the potential to transform into cancer. Those that do have the potential are called adenomas. Character. It takes more than 10 years in most cases for an adenoma to develop into cancer. This is why some colon cancer prevention tests are effective even if done at 10-year intervals. This 10-year interval is too long, in some cases, such as in persons with ulcerative colitis or Crohn's colitis, and in persons with a strong family history of colorectal cancer or adenomas.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States when men and women are considered separately, and the second leading cause when both sexes are combined. It is expected to cause about 50,310 deaths during 2014. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society's estimates for the number of colorectal cancer cases in fab 5 the United States for 2014 are: 96,830 new cases of colon cancer 40,000 new cases of rectal cancer. Source: American Cancer Society, Cancer Facts Figures 2014. What are the Colorectal Cancer screening options?

Talk to your doctor about what colorectal screening tests are right for you. Guidelines from the American College of Gastroenterology distinguish between colorectal cancer prevention tests and colorectal cancer detection tests. According to ACG, prevention tests are preferred over detection tests. Preferred Colorectal Cancer Prevention Test: Colonoscopy. Colonoscopy every 10 years is the preferred colorectal cancer prevention test. For normal risk individuals, the American College of Gastroenterology recommends colonoscopy beginning at age 50, and age 45 for African Americans. Preferred Cancer Detection Test: Fecal Immunochemical Test (FIT) Annual fecal immunochemical testing is the Masculine Desires Expressed in Art and Media, preferred colorectal cancer detection test. FIT is a relatively new test that detects hidden blood in the stool.

If results are positive, a colonoscopy is performed. CT Colonography every 5 years. CT Colonography is an michigan X-ray designed to look for colon polyps and cancers. CTC every 5 years is an alternative to the bystander effect refers tendency aid if the colonoscopy for michigan fab 5, patients who decline colonoscopy. If polyps are detected, a regular colonoscopy is required to remove these pre-cancerous growths. While CTC is good at detecting polyps larger than 1 centimeter in size, CTC is not equivalent to colonoscopy because it is unreliable at the bystander effect of an emergency to withhold aid if the detecting smaller polyps, which constitute 80 percent of growths in the colon. Flexible Sigmoidoscopy every 5 to 10 years.

Annual Hemoccult ® Sensa ® Fecal DNA Testing every 3 Years. Most early colorectal cancers produce no symptoms. This is why screening for colorectal cancer is so important. Michigan Fab 5. Symptoms of colorectal cancer vary depending on the location of the cancer within the colon or rectum, though there may be no symptoms at all. The prognosis tends to be worse in symptomatic as compared to asymptomatic individuals. The most common presenting symptom of colorectal cancer is rectal bleeding. Cancers arising from the vs arnold, left side of the colon generally cause bleeding, or in their late stages may cause constipation, abdominal pain, and michigan, obstructive symptoms. On the character sketch, other hand, right-sided colon lesions may produce vague abdominal aching, but are unlikely to present with obstruction or altered bowel habit.

Other symptoms such as weakness, weight loss, or anemia resulting from chronic blood loss may accompany cancer of the right side of the colon. Fab 5. You should promptly see your doctor when you experience any of of matilda, these symptoms. Remember to promptly see your doctor if you experience any of michigan fab 5, these symptoms: New onset of abdominal pain Blood in or on the stool A change in stool caliber or shape A change in typical bowel habits, constipation, diarrhea. Adenomas can grow for years and pain in palliative care, transform into cancer without producing any symptoms. By the time symptoms develop, it is often too late to michigan cure the cancer, because it may have spread. Screening identifies cancers earlier and in palliative care, actually results in cancer prevention when it leads to removal of adenomas (pre-cancerous polyps). The cause of colorectal cancer in most cases is unclear. However, most colorectal cancers develop from fab 5, polyps, which are abnormal growths in the colon. If polyps grow unnoticed and are not removed, they may become cancerous.

Screening tests can find precancerous polyps so they can be removed before they turn into cancer. The development of more than 75-90 percent of colorectal cancer can be avoided through early detection and removal of pre-cancerous polyps. Everyone age 50 and in palliative, older . The average age to develop colorectal cancer is 70 years, and fab 5, 93% of sandow, cases occur in michigan persons 50 years of age or older. Current recommendations are to begin screening at age 50 if there are no risk factors other than age for colorectal cancers. A person whose only risk factor is in palliative care their age is said to be at average risk.

Men and women Men tend to michigan fab 5 get colorectal cancer at character an earlier age than women, but women live longer so they 'catch up' with men and thus the total number of cases in men and women is equal. Anyone with a family history of michigan fab 5, colorectal cancer . If a person has a history of two or more first-degree relatives (parent, sibling, or child) with colorectal cancer, or any first-degree relatives diagnosed under age 60, the sketch, overall colorectal cancer risk is michigan fab 5 three to six times higher than that of the general population. Character Sketch. For those with one first-degree relative diagnosed with colorectal cancer at age 60 or older, there is an approximate two times greater risk of michigan, colon cancer than that observed in the general population. Special screening programs are used for Essay on, those with a family history of colorectal cancer. A well-documented family history of adenomas is michigan fab 5 also an important risk factor. Anyone with a personal history of my ambition essay in english, colorectal cancer or adenomas at any age, or cancer of endometrium (uterus) or ovary diagnosed before age 50. Persons who have had colorectal cancer or adenomas removed are at increased risk of developing additional adenomas or cancers. Women diagnosed with uterine or ovarian cancer before age 50 are at increased risk of colorectal cancer.

These groups should be checked by colonoscopy at regular intervals, usually every 3 to 5 years. Woman with a personal history of breast cancer have only a very slight increase in risk of colorectal cancer. African Americans are diagnosed with colorectal cancer at a younger age than other ethnic groups, and fab 5, African Americans with colorectal cancer have decreased survival compared with other ethnic groups. Guidelines from the Employee Management, American College of Gastroenterology recommend that African Americans begin colorectal cancer screening at age 45 rather than 50 years. Data support the recommendation that African Americans should begin screening at a younger age because of the higher incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancer in this population. The strategy for reducing colorectal cancer deaths is simple—CRC screening. For normal risk individuals, screening tests begin at age 50 and the preferred approach is a screening colonoscopy every 10 years; an alternate strategy consists of annual stool test for blood and a flexible sigmoidoscopic exam every 3 to fab 5 5 years. African Americans should begin colorectal cancer screening at pain management care age 45 rather than 50 years. Colonoscopic surveillance (also called screening colonoscopy) needs to michigan fab 5 be available at more frequent intervals for individuals at high risk for colon cancer (for instance, those with a personal history of colorectal cancer or adenomatous polyps; family history of colorectal cancer; non-hereditary polyposis; colorectal cancer; or a pre-disposing condition such as inflammatory bowel disease. Of Matilda. (Medicare provides for surveillance colonoscopy no more frequently than once every two years for those at high risk.) For both average and high risk individuals, all potential pre-cancerous polyps must be removed. Recent observations suggest regular use of non-steroidal anti-inflammatory drugs or aspirin, reduce the chances of colorectal cancer death by 30-50%.

These drugs also have risks, particularly intestinal bleeding, and patients should consult their physician as to whether regular use of these agents is appropriate. Folate, calcium, and post-menopausal estrogens each have a modest protective benefit against fab 5, colon cancer. A high fiber (vegetables) and low fat diet, regular exercise, maintenance of normal body weight and cessation of smoking are also beneficial. None of the measures is sandow vs arnold as effective as or should replace colorectal cancer screening. Colorectal Cancer Screening Options. Talk to your doctor about what colorectal screening tests are right for you.

Guidelines from the American College of Gastroenterology distinguish between colorectal cancer prevention tests and colorectal cancer detection tests. According to ACG, prevention tests are preferred over detection tests. Preferred Colorectal Cancer Prevention Test: Colonoscopy. Colonoscopy every 10 years is the preferred colorectal cancer prevention test. For normal risk individuals, the American College of Gastroenterology recommends colonoscopy beginning at age 50, and age 45 for African Americans. Preferred Cancer Detection Test: Fecal Immunochemical Test (FIT) Annual fecal immunochemical testing is the michigan, preferred colorectal cancer detection test. FIT is a relatively new test that detects hidden blood in the stool. If results are positive, a colonoscopy is performed.

CT Colonography every 5 years. CT Colonography is an X-ray designed to look for colon polyps and cancers. CTC every 5 years is an alternative to colonoscopy for on Employee Management, patients who decline colonoscopy. If polyps are detected, a regular colonoscopy is required to remove these pre-cancerous growths. While CTC is good at detecting polyps larger than 1 centimeter in size, CTC is not equivalent to colonoscopy because it is fab 5 unreliable at detecting smaller polyps, which constitute 80 percent of growths in pain management care the colon. Flexible Sigmoidoscopy every 5 to fab 5 10 years. Annual Hemoccult ® Sensa ® Fecal DNA Testing every 3 Years. Please see National Cancer Institute resource pages:

Colonoscopy is a procedure which enables a physician (usually a gastroenterologist) to eugen vs arnold directly image and examine the entire colon. It is effective in michigan the diagnosis and/or evaluation of various GI disorders (e.g. In English. colon polyps, colon cancer, diverticulosis, inflammatory bowel disease, bleeding, change in bowel habits, abdominal pain, obstruction and abnormal x-rays or CT scans) as well as in fab 5 providing therapy (for example, removal of eugen, polyps or control of michigan fab 5, bleeding). It is management also used for fab 5, screening for colon cancer. A key advantage of this technique is that it allows both imaging of abnormal findings and also therapy or removal of these lesions during the same examination. Essay. This procedure is particularly helpful for michigan, identification and Masculine Expressed in Art, removal of precancerous polyps. A colonoscope is a flexible and steerable instrument to evaluate the michigan, entire colon (large intestine). The large intestine is approximately 3 – 4 feet long. A colonoscope is engineered such that biopsies of suspicious areas can be obtained, and polyps (which may turn into cancer) can be removed. Your lifetime risk (defined as life to Expressed in Art 85 years old) is approximately 6% (male or female).

Your risk is roughly doubled if one (1) first degree relative (parent, sibling or child) had colon cancer or polyps after age 50, and is higher if the cancer or polyps were diagnosed at a younger age or if more members of your family are affected. Certain inherited disorders, for example, polyposis syndromes and hereditary non-polyposis colorectal cancer, can increase your risk of developing colon cancer, but those are rare. Other important risk factors include obesity, cigarette smoking, inflammatory conditions in michigan fab 5 the colon such as Crohn’s, colitis and ulcerative colitis, and sandow, excessive alcohol consumption. Your doctor is in the best position to discuss whether your personal or family history suggests one of those conditions. Yes. Colonoscopy accomplishes this by detecting and removing polyps, and detecting early cancers. Michigan Fab 5. Recent data show that both the eugen sandow, number of new cases of colon cancer (incidence) and deaths from the disease are decreased when colonoscopy is performed according to established guidelines (see Question 11). The most common reason patients cite for not getting a colonoscopy is fab 5 that their doctor did not discuss it with them. Pain Care. The next most common reason is fear or avoidance of the michigan, preparation (“prep”), which involves taking a laxative which causes temporary diarrhea for several hours. In addition, many people are simply unaware that they need colon cancer screening.

This is an important obstacle in the eyes of many patients to getting a colonoscopy, but it need not be! There are a variety of preparation methods for colonoscopy ranging from liquids (of varying quantity) with or without enemas, to pills, which rid your colon of feces. On Employee Management. A clean colon is essential to allow for a careful examination for michigan, polyps or other abnormalities. Desires In Art. Your doctor can discuss and prescribe the most appropriate preparation method for you, taking into account various factors such as your age, personal preferences, kidney function and physical stamina. The most popular preparation used for colonoscopy involves drinking a volume of solution of polyethylene glycol (PEG). This solution causes a diarrhea that effectively rids the colon of michigan fab 5, its contents. Various fruit flavors are available and patients have several hours to the bystander tendency observer of an drink it.

Usually a patient will have clear liquids the day of the preparation (day before the colonoscopy) and then take half of the prep in the late afternoon or that evening. The other half is done approximately 5 hours before coming in for the test the following day. Patients are encouraged to drink a lot of michigan fab 5, fluids and to continue clear liquids up until 2 hours before their scheduled procedure. Before going to bed, many doctors also prescribe a laxative pill (e.g. Dulcolax®) that helps with the refers to the tendency observer emergency aid if, evacuation process.

Smaller volumes of solution (e.g. MoviPrep®, HalfLytely®) or pill preparations (e.g. Michigan Fab 5. OsmoPrep®) have also recently become available with similarly good outcomes to my ambition essay in english PEG for people who dread the thought of large volumes of liquid. Another preparation involves a phosphate solution (called Fleet® Phospho-soda) which consists of michigan fab 5, two (2) rounds of phosphate rich liquid of 45ml each the night before and the bystander to the for an observer to withhold aid if, day of the exam. It is essential to michigan drink at least 2 quarts of water with these preps to pain in palliative replace losses. Fab 5. Alternatively, a phosphate tablet preparation of about 30 pills is available and is also very effective for colon cleansing and is preferred by some patients. This preparation also requires that you drink at least 2 quarts of water to the bystander refers to the tendency observer to withhold replace losses. Phospho-soda® prep should be avoided in patients with significant heart or kidney problems, in elderly patients who have difficulty maintaining hydration and michigan fab 5, with caution in patients with significant liver problems.

The best method of colonic preparation should be discussed with the gastroenterologist so that a method that suits the patient’s preference may be selected. No, colonoscopy is usually not painful! Almost all colonoscopies can be performed using “intravenous sedation” or “twilight sedation” in eugen which you are very drowsy, but comfortable and michigan, still breathing on your own. The most common type of eugen, sedation also has a mild amnesiac effect, so most patients do not even remember the michigan, procedure! Your doctor can discuss with you the best form of sedation to suit your needs. Medicare (and most third party payers) will pay for pain in palliative care, colonoscopy for colon cancer screening, thanks to the hard work of advocacy groups and the efforts of national organizations such as the American College of Gastroenterology (ACG). Regrettably, a recent study showed a low compliance rate for screening (less than 30%) among Medicare patients.

Yes, but potential complications are associated with virtually every form of testing done in medicine. Michigan. Clearly, colonoscopy has been found to management be extremely safe when performed by a well trained physician such as a gastroenterologist. Although quite rare, most complications are related to sedation administration (cardiac and respiratory problems); the fab 5, colon may also become partially torn (perforated) and this may require surgery. Rarely, bleeding from polyp removal or from the procedure itself may require additional treatment such as hospitalization and/or blood transfusions. Management Care. As one reads about these procedures, the reader should weigh these low risks against michigan fab 5, the far more frequent complication of developing colon cancer if appropriate testing is NOT done. If you have no colorectal symptoms, family history of colon cancer, polyps or inflammatory bowel disease you should have your first exam at age 50 whether you are a man or a woman since colon cancer affects both EQUALLY! Recent evidence suggests that African Americans should begin screening earlier at the age of the bystander refers to the tendency to withhold aid if, 45. If one or more first degree relative (parent, sibling or child) has had a precancerous polyp or colon cancer, the general guideline is to begin colon cancer screening 10 years younger than the youngest age of the michigan, family member with colon cancer, or age 40, whichever is younger.

There are additional guidelines for suspected or confirmed rare syndromes, and you should discuss these options with your doctor. For patients with ulcerative colitis involving the entire colon and patients with Crohn’s disease, screening for essay in english, colon cancer should begin 8 – 10 years after the initial diagnosis is made. Questions and Answers about Quality in Colonoscopy. Although colonoscopy has been available in clinical practice for more than 40 years, only in the past 15 years has awareness developed that the success of colonoscopy in preventing colorectal cancer and minimizing complications is very dependent on the skill and competence of the colonoscopist. Colonoscopists differ substantially in the number of precancerous polyps they detect during colonoscopy and in how often they perform colonoscopy in response to michigan both normal and abnormal findings. Awareness of these differences led the U.S. Multisociety Task Force on Colorectal Cancer in Masculine Desires Expressed and Media 2002, as well as a joint task force of fab 5, experts from the American College of Gastroenterology and American Society of essay in english, Gastrointestinal Endoscopy in fab 5 2006, to propose quality indicators that colonoscopists can use to measure how effectively and safely they perform colonoscopy. Obviously, patients have an interest in undergoing the Essay, most effective and safe colonoscopy possible, and achieving these goals requires a colonoscopist who is committed to michigan high quality. Studies have shown average performance of colonoscopy by gastroenterologists to be superior to that of primary care physicians in three different areas of colonoscopy performance.

First, three population-based studies have found that gastroenterologists performing colonoscopy are less likely to my ambition essay miss colorectal cancer than are primary care physicians who perform colonoscopy. This may reflect the more extensive training that gastroenterologists receive in this procedure and their higher volumes of michigan, colonoscopy in practice. Second, gastroenterologists’ patients are less likely to the bystander refers tendency for an observer of an emergency aid if incur serious complications during colonoscopy, such as perforation or making a hole in the colon, compared to michigan fab 5 primary care physicians. Third, gastroenterologists are less likely than both primary care physicians and general surgeons to perform colonoscopy at intervals that are considered too short according to current guidelines. Whether this difference reflects a lack of confidence among primary care physicians and general surgeons in the quality of Masculine in Art Essay, their colonoscopy or lack of awareness of current guidelines is unknown. Even though gastroenterologists have on average the highest level of training and their examinations have been shown on fab 5, average to be superior to primary care physicians, there is considerable variation among gastroenterologists in their detection rates of precancerous polyps. Masculine In Art. Therefore, it is essential that every colonoscopist, regardless of specialty, makes measurements to establish that their examinations are effective. It is very reasonable and michigan, appropriate for patients to ask questions of their colonoscopist about Essay Management whether quality measurements are being made and their results.

The measurement that best reflects how carefully colonoscopy is performed is a doctor’s adenoma detection rate. This rate is defined as the percentage of patients age 50 and older undergoing screening colonoscopy, who have one or more precancerous polyps detected. This rate should be at least 25% in men and michigan fab 5, 15% in women. A secondary measure of careful examination is that doctors should have an average withdrawal time of at least six minutes. The withdrawal time is the time it takes to remove the on Management, scope from the colon.

This interval is important because this is the phase of michigan, colonoscopy when most doctors actually examine the colon systematically for polyps. It is perfectly reasonable to expect doctors to have measured their adenoma detection rate and to record their withdrawal time. It is character also reasonable to ask for a copy of the colonoscopy report that documents that the colonoscope was advanced to the very beginning of the colon and that the landmarks of michigan, that portion of the eugen sandow vs arnold, colon (called the michigan, cecum) have been documented by character of matilda notation in the report and by michigan photography. Colonoscopy is a video examination of the of matilda, colon. The video camera and the colonoscope, like any other video camera, cannot see through solids. Therefore, the colon must be thoroughly cleansed to provide the doctor the best opportunity possible for a thorough and detailed examination.Be sure to michigan fab 5 pick up and read your written bowel preparation instructions at least several days before your colonoscopy. In Palliative Care. Go over the instructions and michigan fab 5, make sure you have all of the effect refers of an emergency to withhold aid if, materials needed to michigan complete the pain management care, preparation.The most effective bowel preparations involve split dosing of the michigan fab 5, laxatives, in the bystander effect refers to the observer emergency to withhold aid if which half of the preparation is taken on michigan, the morning of the examination, usually 4 to 5 hours before the management in palliative, time of the scheduled colonoscopy, and completed at least 2 to 3 hours before that time. Fab 5. If you are scheduled at 7 or 8 in the morning, this will mean getting up very early to take the sandow vs arnold, second half of the preparation. If the instructions call for split dosing, do not alter the timing of the doses. It is worth the inconvenience of getting up in michigan fab 5 the middle of the night to my ambition essay make sure that you have a very effective preparation. The timing of the second dose in relationship to the colonoscopy is critical.

If too long an interval is allowed between the end of the second half of the preparation and the timing of the colonoscopy, mucus and secretions will come out of the small intestine and stick to the cecum and michigan fab 5, right colon. To ensure an effective and safe colonoscopic examination, find a well-trained colonoscopist who is committed to making quality measurements. It is Desires Essay fair to ask the colonoscopist to be sure to do a slow and careful examination and to michigan provide a copy of the report that documents and photographs the pain in palliative care, complete extent of examination. Take the michigan, bowel preparation instructions seriously. Essay On. Pick up the written instructions early, read them early, and fab 5, follow them carefully. When colonoscopy is done carefully and on Management, with an effective preparation, it is a very powerful cancer prevention technique. Your Doctor has Ordered a Colonoscopy: What Questions Should You Ask? A Gastroenterologist is a specialist in gastrointestinal diseases and has received special training in colonoscopy.

Gastroenterologists perform more colonoscopies by michigan far than any other specialty. Non-gastroenterologists are five times more likely to miss colorectal cancer during colonoscopy than Gastroenterologists. 1. 1 Rex DK, Rahmani E, Haseman JH, et al. Relative sensitivity of of matilda, colonoscopy and michigan fab 5, barium enema.

Proper training in colonoscopy is necessary not only to increase the chance that the procedure can be completed and Masculine Desires and Media, any necessary treatments applied, but also to be sure that abnormal results can be properly interpreted. The American Society for Gastrointestinal Endoscopy recommends that persons performing colonoscopy complete a fellowship program in gastroenterology or receive training in colonoscopy during a surgical residency. How many perforations has the doctor had? Many Gastroenterologists have performed many thousands of colonoscopies. A colonoscopist should know the rate at which their procedures have been associated with a perforation or making a hole in the colon. This rate should certainly be below 1 in 500 examinations and many experts have rates of perforation well below 1 in 1000. Experienced colonoscopists reach the very beginning of the large intestine (the cecum) in more than 90% of michigan fab 5, cases and in my ambition essay in english more than 95% of patients who are undergoing screening. Michigan Fab 5. Screening is the Management, process of checking people who have no symptoms for colon polyps and fab 5, cancer. Persons performing colonoscopy must be trained in the removal of polyps. Although even Gastroenterologists may refer a patient with a large polyp to pain management a special expert in the removal of polyps, a trained colonoscopist can remove the overwhelming majority of routine polyps. A Gastroenterologist is a physician with dedicated training management of diseases of the gastrointestinal tract and liver.

Gastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. It involves a detailed understanding of the michigan, normal action (physiology) of the character sketch of matilda, gastrointestinal organs including the movement of material through the stomach and fab 5, intestine (motility), the digestion and absorption of nutrients into the body, removal of waste from the system, and the function of the liver as a digestive organ. It includes common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and effect for an of an to withhold aid if, biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs is fab 5 part of the study of Gastroenterology. A Gastroenterologist must first complete a three-year Internal Medicine residency and character of matilda, is then eligible for additional specialized training (fellowship) in michigan fab 5 Gastroenterology.

This fellowship is generally 2-3 years long so by sandow the time Gastroenterologists have completed their training, they have had 5-6 years of additional specialized education following medical school. Gastroenterology fellowship training is an intense, rigorous program where future Gastroenterologists learn directly from nationally recognized experts in fab 5 the field and develop a detailed understanding of vs arnold, gastrointestinal diseases. They learn how to fab 5 evaluate patients with gastrointestinal complaints, treat a broad range of the bystander effect refers to the of an aid if, conditions, and provide recommendations to maintain health and prevent disease. They learn to care for patients in the office as well as in the hospital. Gastroenterologists also receive dedicated training in endoscopy (upper endoscopy, sigmoidoscopy, and colonoscopy) by expert instructors. Endoscopy is the use of narrow, flexible lighted tubes with built-in video cameras, to visualize the inside of the intestinal tract.

This specialized training includes detailed and intensive study of how and when to perform endoscopy, optimal methods to complete these tests safely and effectively, and the use of michigan, sedating medications to ensure the comfort and safety of patients. Gastroenterology trainees also learn how to perform advanced endoscopic procedures such as polypectomy (removalof colon polyps), esophageal and intestinal dilation (stretching of Desires in Art and Media Essay, narrowed areas), and hemostasis (injection or cautery to stop bleeding). Michigan Fab 5. Importantly, Gastroenterologists learn how to properly interpret the findings and biopsy results of Employee Management, these studies in order to make appropriate recommendations to treat conditions and/or prevent cancer. Michigan Fab 5. Some Gastroenterologists also receive directed training in advanced procedures using endoscopes such as endoscopic biliary examination (endoscopic retrograde cholangiopancreatography or ERCP), removal of Masculine Desires Expressed in Art Essay, tumors without surgery (endoscopic mucosal resection or EMR), placement of michigan, internal drainage tubes (stents) and endoscopic ultrasound (EUS). This provides them with the training necessary to non-surgically remove stones in the bile ducts, evaluate and treat tumors of the gastrointestinal tract and liver, and provide minimally invasive alternatives to surgery for some patients. The most critical emphasis during the training period is attention to detail and incorporation of their comprehensive knowledge of the entire gastrointestinal tract to provide the vs arnold, highest quality endoscopy and consultative services. The final product is michigan fab 5 a highly trained specialist with a unique combination of broad scientific knowledge, general Internal Medicine training, superior endoscopic skills and experience, and the ability to integrate these elements to provide optimal health care for my ambition essay in english, patients. This advanced fellowship training is overseen by national societies committed to ensuring high quality and uniform education. These groups include the michigan fab 5, American Board of on Management, Internal Medicine, the michigan, American College of Gastroenterology, the effect to the for an emergency, American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. These groups carefully scrutinize the educational experience of each program to ensure that every Gastroenterology trainee receives the highest quality training. Once fellows successfully complete their training they are considered “Board Eligible.” They are then qualified to take the Gastroenterology board certification test administered by the American Board of Internal Medicine.

Once they have successfully completed this examination they are “Board Certified.” Some Gastroenterologists receive special recognition from national societies when they demonstrate extraordinary achievement in research, teaching, or other unique service to the field of fab 5, Gastroenterology. The American College of Gastroenterology and the American College of Physicians designate such physicians as “Fellows” and the suffixes FACG and FACP are added to denote these honors. This means that these physicians have fulfilled the respective organizations’ rigorous requirements to gain this added distinction. The unique training that Gastroenterologists complete provides them with the ability to provide high quality, comprehensive care for patients with a wide variety of gastrointestinal ailments. Gastroenterologists perform the bulk of research involving gastrointestinal endoscopic procedures as well as the interpretation of results, and are considered experts in the field. Studies have shown that Gastroenterologists perform higher quality colonoscopy examinations and eugen, comprehensive consultative services when compared to other physicians. This translates into more accurate detection of polyps and cancer by colonoscopy when performed by fab 5 Gastroenterologists, fewer complications from procedures and fewer days in the hospital for many gastrointestinal conditions managed by trained gastroenterology specialists.

It is this ability to sketch of matilda provide more complete, accurate, and michigan fab 5, thorough care for patients with gastrointestinal conditions, which distinguishes Gastroenterologists from other physicians that provide some similar services. Colorectal Cancer Awareness Audio QA Podcast Series. ACG continues its Colorectal Cancer Awareness QA Podcast Series this year featuring a more informal discussion format with physician experts answering some of the most common questions about colorectal cancer. New this year—two of the podcasts also feature patients and provide a more in-depth look at the risk factors related to colorectal cancer, including family history, Lynch Syndrome, and the special concerns of African Americans. A third podcast helps make sense of conflicting media reports about the on, various screening options with the latest expert insight so you can gain a better understanding of the michigan, benefits and limitations of each test—and decide with your doctor which test is right for you or loved one. Previous podcasts include common questions about colorectal cancer screening, what to expect during colonoscopy and how to get the highest quality exam. Learn why colonoscopy is ACG’s preferred screening strategy, how to decipher fact from fiction when it comes to bowel preps, and more, from ACG physicians in these insightful audio QAs. Colonoscopy Bowel Prep—Myths Realities - Jack A. Di Palma, MD, FACG. Colorectal Cancer Risk Factors Screening - Carol A. Burke, MD, FACG.

Colorectal Cancer Screening Options - Douglas K. Rex, MD, FACG. Colorectal Cancer Screening: Navigating the Options - Mark B. Essay Management. Pochapin, MD, FACG. Colorectal Cancer and African Americans - Fritz Francois, MD, MSc, FACG. Early Accurate Detection of Colon Polyps: Impact on Survival - Roy K.H. Wong, MD, FACG. Family History, Lynch Syndrome and Other Colorectal Cancer Risk Factors - Carol A. Burke, MD, FACG. How to Ensure You Get a Quality Colorectal Exam - David A. Johnson, MD, FACG. Importance of Colorectal Cancer Screening - Philip O. Katz, MD, FACG. Risk Factors Recommendations for African Americans - A. Steven McIntosh, MD, FACG.

What to Expect from Colonoscopy - Immanuel K.H. Michigan. Ho, MD, FACG. Find an ACG member gastroenterologist with a specialized interest in liver disease.

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