Nonsurgical Endodontic Management Case Study

Nonsurgical Endodontic Management Case Study Introduction The main aim of any endodontic treatment is to thoroughly debride and disinfect the root canal system followed by the contouring of root canal walls and apical tip, for the purpose of sealing the root canal completely with a condensed, inert filling material. Failure to acknowledge the presence of an additional root canal during an endodontic treatment is amongst the major causes of an endodontic treatment failure. Other causes include inappropriate canal instrumentation, incomplete obturation and untreated major canals. An important key to success of any root canal treatment is proper understanding of the anatomy of root canal system this can be achieved by knowledge of the morphology of the root and root canal systems of teeth and diagnostic imaging techniques are required for successful root canal treatment, especially in mandibular premolar teeth (England et al. 1991). In-depth knowledge about the occurrence of atypical external and internal root canal morphologies contributes to the success of root canal treatment. It has been indicated by slowey that due to the variations in the root canal anatomy of mandibular premolars, they have a high flare up and failure rate and are hence the most difficult teeth to treat. Both the mandibular first and second premolars most often have a single root and a single canal, however, anomalies of the root and root canal systems as well as multiple canals have been reported in the literature (Baisden et al. 1992, Robinson et al. 2002).4 Zillich and Dowson have, in a definitive anatomical study, unveiled the occurrence of three canals in mandibular second premolars to be 0.4%.5 The mandibular first premolars show a large variation in the occurrence of number of root canals and apical foramina. Data from anatomical studies report that three rooted mandibular first premolars are rare, about 0.2%.6 This case report presents a case of a successful nonsurgical endodontic management of a mandibular first premolar with three separate roots using Cone Beam Computed Tomography (CBCT). Case Report A twenty four year old female patient of Indian origin, with the chief complaint of intermittent pain along with food lodgement in the lower left back region of jaw since 3 months, was referred to the Post Graduate Department of Conservative Dentistry and Endodontics. Patient also complained of bleeding from gums while brushing since eight months. Medical and dental history was non-contributory. On clinical examination, patients oral hygiene was found to be moderate. Deep occlusal carious lesion was seen with respect to tooth # 34 and 35 and both the teeth were found to be tender on percussion, with no associated periodontal pockets. Neither the affected nor the contralateral side of the crown of the mandibular first premolar showed any unusual anatomy in terms of number of cusps and dimensions. A lingering response was seen on heat testing and electric pulp testing. No evidence of swelling or sinus tract was seen. Intra oral periapical radiographic evaluation of the involved tooth revealed normal mandibular first premolar root anatomy. There was widening of the periodontal ligament space with periapical radiolucency around the root of tooth #34. A diagnosis of irreversible pulpitis was made based on clinical and radiographic evidences. After the administration of local anesthesia (2% Lidocaine with1:80,000 adrenaline), access was gained to the pulp chamber under isolation and conventional access opening was done to locate the canal. Tactile examination of the walls of the major canals was done with a small precurved pathfinder file, while locating the canal, which was proceeded slowly down each wall of the major canal, probing for a catch. A slight catch may indicate the orifice of an additional canal, especially in case of the buccal and lingual walls, because these are not generally visible on the radiograph. . On thorough inspection of the pulp chamber floor, three separate root canal orifices were detected (one mesiobuccal, one mesiolingual, and one distal). With the help of a pathfinder file, access cavity was temporarily sealed with Cavit, and to confirm the root morphology, the patient was referred to an oral and maxillofacial radiologist for a cone-beam computed tomography. CBCT of the mandible was performe d using the CS 3D imaging, after obtaining an informed consent of the patient. A three-dimensional image of the mandible was obtained. The involved tooth was focused, and the morphology was obtained in transverse, axial, and sagittal sections with a thickness of 0.48 mm, along with three-dimensional reconstructed images. The axial image obtained from CBCT confirmed the presence of three roots in mandibular first pre molar # 34. The roots were found to be mesiobuccal, mesiolingual and distal . After re-isolating the tooth, coronal flaring of all the three canals was carried out using Gates Glidden drills and working length was determined using an apex locator, which was later confirmed by a radiograph. The canals were cleaned and shaped up to ISO #35 masterapical file under copious irrigation with 2.5% sodium hypochlorite and 17% EDTA. The root canals were dried with sterile paper points, followed by temporary sealing of the access cavity with Cavit (3M ESPE AG, Seefeld, Germany). The patient was re-scheduled a week after for follow up. The tooth was found to be completely asymptomatic after a week, and the roots canals were obturated by cold lateral compaction of gutta-percha using AH26 sealer (Kemdent; Associated Dental Products Ltd, Wiltshire, UK). A postoperative radiograph was taken (Figure 3B), and the access cavity was permanently restored using universal amalgam restorative material. Discussion Diagnosis and management of extra roots and root canals in mandibular premolars is one of the major challenges in endodontics. 8-18 Therefore, the clinician must have an appropriate knowledge about the normal root canal anatomy and the most common variations associated. Inability to find, debride and obturate a root canal has been reported to be a major reason for failures in endodontic treatment. 19Based on race, only one study by Trope et al. has showed an increased prevalence of two or more canals in mandibular first premolar in African American patients as compared to Caucasian American patients .20 The failure rate in mandibular first premolar was shown to be 11.45% according to the Washington study. 21This might be due to the extreme variations in the root canal morphology of the mandibular premolar teeth and therefore poses an endodontic challenge to the clinician. Considering the high prevalence of aberrations in these teeth, an endodontist must suspect the presence of one or more missed canals, when a patient returns with persistent post-operative pain or sensitivity to hot and cold. Judicious use of high-end diagnostic aids should also be considered in such cases. Radiographs obtain two-dimensional images of three dimensional objects, resulting in superimposition of the images. Therefore, they are of limited use in complex root canal anatomy cases. Interpretation based on a two-dimensional radiograph may circumspect the clinician of the presence of aberrant root canal anatomy but cannot completely show the morphological structure of the root canals and their interrelations .22 Based on the results of previous studies carried out by Kottoor et al., and La et al. wherein spiral CT was used for the confirmatory diagnosis of morphological aberrations in the root canal anatomy, CBCT of the involved tooth was planned in the present case .23-25 The 3D CBCT images in this study revealed three roots (mesiobuccal, mesiolingual and distal ), with three distinct canals, each canal having a separate apical orifice as compared to the two dimensional radiograph which showed only one root, just like the anatomy of a typical single-rooted mandibular first premolar, that led to a false diagnosis and treatment plan. This is probably why the mandibular first premolar is known as an enigma to the endodontist. However, the high cost and inaccessibility to the patient as well as the extra radiations as compared to the standard radiographic methods makes its routine use limited.We can therefore conclude that a thorough knowledge of the root canal anatomy and its variations, careful interpretation of the radiographs, close clinical examination of the floor of the chamber and proper techniques of access opening along with adequate magnification are essential for successful treatment outcome. Conclusion The mandibular premolar teeth can present with extremely complex root and root canal system morphology, and if not considered during treatment can lead to difficulties when performing root canal treatment. The use of 3D CBCT is a valuable tool in studying the variations that may occur in root canal anatomy.

Responsibilities and Relationships in Education and Training Essay

The Teaching Role and Responsibilities In Education And Training The role of ‘teacher’ is an infinitely varied one, but there certain principles which underpin all aspects of the teaching role. Whether we are attempting to teach from personally acquired experience or knowledge, or from third party information, the process of teaching can be formalized into a structured process with the aim of maximizing the potential for learning. Numerous models exist with the aim of outlining the key stages of this process. For example, Gravells (2010) identifies them as such: Identification of Need →Planning and Design→Delivery/Facilitation→Assessment→Evaluation In order to undertake each of these stages successfully, the role of the teacher becomes multi-faceted. For example, conducting initial interviews with students helps to establish individual aims and identify particular learning styles such as those recognised by Honey & Mumford (1992). This should enable to the teacher to tailor their teaching style and utilize a variety of methods, while also providing an opportunity to set clear goals which can be used as a benchmark when reviewing students’ progress. Accurate documentation of this is essential and forms part of the teachers’ responsibility. Furthermore, whilst undertaking these roles as a teacher, it is vitally important to consider the parameters in which we must operate. These are most likely to be defined by legal requirement – for example the Equality Act (2010) or the policies or the organization for which we may be working. Ultimately, it is down to the individual teacher to ensure their own professional conduct at all times. References: Equality Act (2010). London: HMSO. Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents Accessed 25/11/2014. Gravells, A (2010) ‘Preparing to Teach in the Lifelong Learning Sector’. 3rd Ed. Exeter: Learning Matters Ltd. Honey P., Mumford A. (1992) ‘The Manual of Learning Styles’ 3rd Ed. Maidenhead, Peter Honey. Summarise Key Aspects Of Legislation, Regulatory Requirements And Codes Of Practice Relating To Own Role And Responsibilities There are many aspects to consider when discussing the conduct of a teacher and the requirements therein. Some of these are legal frameworks, others are more informal but equally important in terms of setting out guidelines for good practice. All of these requirements, when adhered to, help to ensure that as teachers, we are providing a safe, secure and successful learning environment. As students, they provide reassurance that care will be taken to promote inclusivity, maintain trust and ensure wellbeing. Some Codes of Practice will be designed to suit individual environments and will vary accordingly. Therefore care should be taken to ensure we are familiar with the particular requirements of the company or institution in which we are operating. Other codes are overarching and apply in all circumstances. One of the more recent of these is the ‘Statutory Special Educational Needs and Disability System for Children And Young People’ (SEND) which came into force on 1 September 2014 and explains the duties of schools and colleges to provide adjustments and aids for disabled children and young people up to 25. Legal acts which are underpinned by law are further reaching but equally apply. These include things such as the long standing 1974 Health and Safety  and Work Act, which ensures the â€Å"health, safety and welfare of persons at work† as well as â€Å"protecting others against risks to health or safety in connection with the activities of persons at work†. However, in the constantly shifting legal landscape, we should be mindful of new legislation coming into force. Finally, there are, of course, directives issued by professional bodies such the Institute for Learning which has a Code of Professional Practice (2008) covering 7 key areas: Integrity Respect Care Practice Disclosure Responsibility References: Department for Education (2014). ‘SEND code of practice: 0 to 25 years’. Available at: https://www.gov.uk/government/publications/send-code-of-practice-0-to-25 Accessed 29/11/2014 Institute for Learning (2008). ‘Code of Practice’ Available at: https://www.ifl.ac.uk/membership/ifl-code-of-professional-practice/view-the-code-of-professional-practice/ Accessed 1/12/2014 Explain Why It Is Important To Identify And Meet Individual Learner Needs As we have established previously, the first step in the (Gravells, 2010). Teaching and Learning Cycle is ‘Identifying need’. Without properly ascertaining this, the further steps in the cycle become more difficult to achieve and the chance for success is significantly diminished. Furthermore, informing learners of objectives creates a level of expectation for learning (Gagne, 1965). In order to avoid this outcome and the negative implications of failing to succeed, we must have a clear approach. Prior to the start of any learning activity, there will, by necessity be a  process which ostensibly is an administrative exercise. However, these interactions provide an excellent opportunity to engage with students in a way which could provide useful information. For example, noting that a student may have difficulty with grammar or spelling when completing a written questionnaire may indicate a greater need for support with literacy. Or, a student struggling to get to grips with viewing digital information such as a Powerpoint or PDF file could highlight a lack of I.T skill. It is important that we use all of these tools at our disposal, as acknowledging a perceived ‘flaw’ in ourselves is not always an easy thing to do. Students may be unwilling because of stigma or embarrassment or simply through an inability to recognize that a problem exists, which is an issue in roughly 30% of adults (Skills for Life Survey, 2011). However, individual needs may not be only be based on academic ability or skillset, there are a multitude of different needs which may exist and it is important to consider a holistic approach. Some students may have no difficulty with course content but may be distracted by other personal problems which affect their ability to learn. These could include financial difficulty, bereavement or an underlying health issue. Ultimately, the importance of identifying and meeting learners’ needs is about providing the best possibility for successful learning through providing support where it is most needed. References: Gagnà ©, R. M. (1965). ‘The conditions of learning and theory of instruction’ (1st ed.) Holt, Rinehart & Winston: New York. Gravells, A (2010) ‘Preparing to Teach in the Lifelong Learning Sector’. 3rd Ed. Exeter: Learning Matters Ltd. Skills for Life Survey (2011). Department for Business, Innovation & Skills. Available at: https://www.gov.uk/government/publications/2011-skills-for-life-survey Accessed 1/12/14. Explain Ways To Maintain a Safe And Supportive Learning Environment As part of providing students with the best opportunity for success, it is crucial that the learning environment is both safe and supportive. These aspects are intertwined in that their aim is to create an environment where consideration for all matters other than the subject itself can be put aside to concentrate on learning. When operating in any environment, safety is the first issue. A risk assessment should be carried out prior to beginning any teaching session to establish whether hazards exist, and if so what extent they pose a risk (Trades Union Congress, 2008). These factors should also be assessed dynamically and any new or developing threat should be treated as a priority. When working in an environment such as a client office or business premises, safety considerations should include awareness of the existing plan of evacuation in case of fire. Any issues which are identified (such as blocked exits etc) should be bought up with the client in a professional manner. Support for learners may be provided in several ways. On a personal level, it is ensuring inclusivity for all students, treating each individual with respect and tolerance, as well as providing individually tailored help to match the needs identified in the first stage of the Teaching and Learning Cycle (Gravells, 2008). However, support is also provided through recognizing the need to give adequate breaks and availability of resources required to undertake the learning process properly. It is vital that consideration is given to these factors in the planning stage so that support may be implemented pro-actively rather than reactively. References: Trades Union Congress (2008) ‘Risk Assessment’. Precision Printing: London. Available online at: http://www.tuc.org.uk/sites/default/files/extras/riskassessment.pdf Accessed 1/12/14 Gravells, A (2010) ‘Preparing to Teach in the Lifelong Learning Sector’. 3rd Ed. Exeter: Learning Matters Ltd. Explain Why It Is Important To Promote Appropriate Behaviour and Respect For Others The importance of appropriate behavior is paramount as it will set the correct tone for a learning environment. Fundamentally, it is about the rights of learners to have access to, attend, and participate in their chosen learning experience regardless of their circumstances. (Equality Act, 2010) The best way to promote this is to set the example as the teacher (School of Educators, 2011). This can be achieved in a variety of ways. Ensuring that the planning of any session has been properly executed will help to demonstrate basic values such as organization, efficiency and punctuality and when delivering a session, using appropriate tone and language will exhibit the kinds of behaviour which we want to see reflected in students. It is also important that we are focused on the task at hand and are not distracted by outside influences. Something as simple as switching off a mobile phone could make all the difference. In that regard, requesting students to put their phones into ‘silent’ mode is something which could help to avoid them becoming distracted but also establishes a basic ground rule while not necessarily conveying the same message as ‘please all turn your phones off’. Where undesirable behaviour occurs, it is important to consider whether addressing it may in fact be more of a disruption than the behaviour itself, however, where it needs to be addressed, this should be done so quickly and professionally. However, it is important to note that students, like teachers should incorporate humour into learning. Using humour in the classroom shows that you are human and consequently encourages students to like and respect you. Being able to laugh at yourself when you make a mistake offers a good counterbalance to the moment when you must be strict and so helps lighten the classroom atmosphere (Cowley, 2007) Treating students as individuals but with equal respect will help to promote the same response from them. Therefore, care should be taken to listen to, appreciate and encourage individual contributions, this is especially true in the case of adult learners who bring their own experiences to the learning setting. References: Cowley, S. (2007) ‘Guerilla Guide to Teaching: The Definitive Resource for New Teachers’ (2nd Ed.) Continuum: London. Equality Act (2010). London: HMSO. Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents Accessed 04/12/2014. School of Educators (2011). ‘The Characteristics of a Good Teacher’. Available online at: http://schoolofeducators.com/2011/05/the-characteristics-of-a-good-teacher/ Accessed 4/12/14. Explain How the Teaching Role Involves Working with Other Professionals As a teacher, there will always be a requirement to liaise and work with other professionals, and this is likely to occur in a number of ways. When employed in a teaching role, we act as a representative of the organization which employs us, and we have a responsibility to represent that organization in a professional manner. Equally, when dealing with internal colleagues, whether a manager or a colleague at the same level of seniority, we are dutybound to treat others with respect, politeness and courtesy. Values which all form part of the Institute for Learning ‘Code of Practice’ (2008). Remembering that we have a responsibility to act according to these guidelines can be especially important when faced with other professionals who may be challenging or difficult in their approach. For example, in a  client situation, a Manager who is under pressure is annoyed because some of his staff are being abstracted from their usual duties to undertake training. In this situation, it is feasible that a degree of hostility may be directed toward the trainer. In acknowledging the managers concerns and highlighting the benefit of the training both to the staff and the manager, we may be able to defuse the situation rather than escalate it. Of course, students themselves can be professionals and care must be taken to acknowledge the professional standing of adult learners so that we do not condescend or patronize. However, we also have a responsibility to care for our students and where it is highlighted that a student may have a need or issue which requires third party support, we may need to act as an advocate or intervene to flag potential issues. Legislation such as The Safeguarding Vulnerable Groups Act (2006) make it potentially necessary to liaise with other professional agencies and, depending on the nature of the matter, it may be appropriate to use care or discretion. In all cases, it is appropriate that we remain professional and impartial. References: Institute for Learning (2008). ‘Code of Practice’ Available at: https://www.ifl.ac.uk/membership/ifl-code-of-professional-practice/view-the-code-of-professional-practice/ Accessed 1/12/2014 Safeguarding Vulnerable Groups Act (2006). London: HMSO. Available at: http://www.legislation.gov.uk/ukpga/2006/47/section/6 Accessed 4/12/14 Explain the Boundaries Between the Teaching Role and Other Professional Roles In dealing with other professional roles, there must come a point at which the boundaries of our own role are recognized to avoid us ‘overstepping the line’. This can apply on either a professional or personal level and works in two ways: our behaviour toward others and their behaviour towards us. The key basis upon which these boundaries must be drawn are ethics. Ethics can be described as ‘The codes of conduct or moral principles recognized in a particular profession, sphere of activity, relationship, or other context or aspect of human life’ (Oxford English Dictionary, 2014) In particular, the teaching profession is deeply implicated in ethical concerns and considerations. (Carr, D. 2000.) Therefore, it is an issue which should be constantly at the forefront of our thinking as teachers and an awareness of ethics helps to define the boundaries between us and other professional roles. Some boundaries are not so much an issue of ethics, however, but more of practicality and there must be limits placed on what we can reasonably be expected to achieve. This could, for example, include something such as a client wishing us to condense a lesson into a shorter time to reduce the impact on their business. Whilst the motivation for this may be understandable, it could also be perceived to undermine the value of the lesson itself, or at the very least will have an effect on the quality of the teaching. Recognising this kind of boundary enables us to ensure the integrity of our aims as teachers. Oxford English Dictionary (2014) Available online at: http://www.oed.com/ Accessed 4/12/14. Carr, D. (2000). ‘Professionalism and ethics in teaching’.London: Routledge Describe Points of Referral To Meet The Individual Needs Of Learners The teacher/student relationship is a unique one and often provides opportunities to unearth or identify needs which have previously been unnoticed. These needs may be specific to helping someone become a more effective learner, (such as possible dyslexia) or could be a wider issue in terms of being affecting the individual students’ life beyond the classroom. These wider-reaching needs could be in any area of a persons’ life and broadly speaking, fall into one of 5 categories as identified by Maslow (1943): Our role in providing support to help a student meet the identified need will depend on the particular need itself. For example, a student who is  apparently lacking in one of the ‘upper needs’ such as self-esteem may benefit from more support, praise and encouragement. Some needs, however, will require external or third party input and this is where we may seek to access a point of referral. It may become clear to us in the process of teaching that a student is suffering a crisis affecting their overall wellbeing: Domestic abuse, homelessness, drug or alcohol misuse etc. In this instance, we can play an important role in referring someone to a service or organization who can provide assistance. So as to be sure that we are not misguided, the student themselves should be engaged initially and when help is offered, it can be simply through providing information, or if consent is given, we may choose to act as an advocate. Maslow, A.H (1943). ‘A Theory of Human Motivation’. Psychological Review (50)p.370-396.

Development or environmental injustice Essay

What does it really take to experience development? What are the defining criteria for development? Is development quantitatively measured or qualitatively evaluated? What are the key indicators of a developing or developed country? The answers depend on the person’s priority and preference. The expansion of metropolitan areas has been referred to as urban development by those who are after the material indicators of development- high rise buildings, wider highways, more cars and more parks. For those who are concerned with the long-term environmental and health effects of urbanization, they call it urban sprawl. For the purpose of having a common point of reference, let me use 1Dr. Howard Frumkin’s definition of urban sprawl: â€Å"the complex pattern of land use, transportation and social and economic development. † This complex pattern requires the extension of urban areas to rural areas, and thus converting the latter to urbanized locality. Urbanization implies vast forest and agricultural lands to be converted to different land uses. Sad to say, the list includes recreational facilities and parks which, for investment and environmental considerations are to be of least priority. Extensive roads construction which provides spaces for suburban dwellers to drive a car just to buy a pack of cigarette in the next block, is not suppose to be of immediate consideration. Besides this qualitative indicators of poor urban sprawl considerations, there are environmental threats of urban sprawl that are needed to be evaluated and be given high priority by the development advocates, as it concerns life of the present and future generations. 2â€Å"Automobile has been a prerequisite to urban sprawl. † (J. E. Anderson) The most adverse effect of heavy reliance to automobiles is obviously air pollution. In the United States, 3about 25% of all trips are shorter than one mile of these, 75% are by car. Another related 4study revealed that only 1% of trips in the US are on bicycle and 9% by foot. Do these figures present impressive urban development rates for the US? I am afraid not because the Netherlands has 30% accounting for transportation on bicycle. These facts rather provide proofs that vehicles are the leading source of air pollution. Despite modern environmental standards, urban air quality remains to be greatly affected by the emission of air pollutants from transport. In the 5US alone, 30% of nitrogen oxide and 30% of hydrocarbon emissions are brought about by mobile sources. In addition, 5carbon dioxide emission, which is the end product of burning fuel such as gas, accounts for 80% emissions. Carbon dioxide is the major greenhouse gas, with global warming potential. Needless to explain, development should no be measured quantitatively, that is by the number of cars that are going to and fro the streets of the cities. Rather, development should be measured qualitatively, that how much does it contribute to the quality of life the residents are to experience when programs relative to urban sprawl are push through. Housing development is a part of urban sprawl, which requires forest fragmentation. 6Chet Arnold of the Center for Land-use and Research at the University of Connecticut said forest fragmentation occurs when â€Å"large, continuous forests are divided into smaller blocks, either by roads, clearing for agriculture, urbanization, or other human development. † This means that housing development requires animal populations in the cleared forests to be thrown out of their natural habitats. Destruction of natural habitats accounts for great loss of biodiversity, which results to ecological imbalance. I agree that man deserve to have decent life and part of it is having a more comfortable living. But humans are not the only residents of the earth. We also have to take into consideration the floras and faunas as part of biodiversity. Let us remember that earth creatures are dependent on each other. Humans, being given the capacity to think and understand over the lower forms of life should see things beyond material and short-term comforts that development brings. Urban sprawl in this context alone is clearly an environmental injustice. Water resources are not exempted from the list of natural resources that are directly affected by urban sprawl. As requisite of urban sprawl deforestation brings forth water pollution. This is besides the effects of pollutants that directly come from factories, sewage treatment plants and local wastes, which are typical to urbanized cities. Rainwater that runs through the deforested lands are not effectively absorbed and thus flows downstream. This process results to lesser groundwater recharge, then water supply shortage follows. Added to the list of negative effects of urban sprawl to natural resources are noise pollution, the heat island effect, soil erosion and the declining fertility rates of soils. The main point of all these is that urban sprawl is the root of many environmental injustices. Air pollution, deforestation, water pollution, soil degradation and the destruction of biodiversity are results of a chain reaction from a single step to what others refer to as urban development. What humans failed to do and still refuse to consider is the future. Development projects, of which urban sprawl is a major player, are focused on comforts and pleasures of today and shortly after tomorrow. The next generation should be taken into serious consideration. There are things that still can be undone, but there are things that cannot. Natural resources that were destroyed can still be replaced, but it takes a century to bring them back to where they used to be. By itself, there’s nothing wrong with development. What makes it undesirable is its planner to consider the future. REFERENCES 1. Frumkin, Howard. Urban Sprawl and Public Health. Public Health Reports. May-June 2002 issue. Volume 117. page 201 2. Anderson, J. Edward. Personal Rapid Transit and Urban Development. Retrieved from http://faculty. washington. edu/jbs/itrans/sprawl. htm on December 19, 2006 3. Koplan, JP, Dietz. Caloric Imbalance and Public Health Policy. JAMA 1999. 282. pages 1579-81 4. Pucher, J. Bicycling Boom in Germany: A Revival Engineered by Public Policy. Transportation Q 1997:51. pages 31-46 5. US Environmental Agency. National Emission Inventory. Air Pollutant Emission Trends. Current Emission Trend Summaries. Retrieved from http://www. epa. gov/ttn/chief/trends/index. html on December 19, 2006 6. NASA. Urban Sprawl: The Big Picture. Retrieved from http://science. nasa. gov/headlines/y2002/11oct_sprawl. htm on December 19, 2006

College Pressures And Eric Greiten s The Heart And The Fist

In today’s society, there is a stigma that one needs a college education to be successful. Due to these overwhelming societal pressures, college students encounter numerous challenges. Two authors who explore these challenges are William Zinsser in his article â€Å"College Pressures† and Eric Greiten in his book â€Å"The Heart and the Fist†. Both Zinsser and Greitens consider the everyday struggles that college students face. While discussing the same topics, the authors use different writing styles and techniques to illustrate the same idea. To begin with, Greitens harnesses his personal experience to outline the pressures he faced during his study abroad trip in China. Specifically, he focuses on the difficulties relating to the actual journey as well as the college workload. Greitens’ writing style captivates the reader. For example, Greitens uses the â€Å"Kung Fu’ story to explain a simple thought. While in his Kung Fu class, the students w ere partaking in different tests that demonstrated each student’s honor. At first, Greitens had hesitations because of his fear of failure. However, he was cautioned by his peers that avoiding the test would indubitably result in social shunning by his mentors. Ultimately, Greitens accepted his fate and the sharp sword pierced his neck, merely leaving behind a small red mark. Because of his willingness to attempt, Greitens passed the test. Combing his own personal memoir and second person narratives, Greitens entices the reader