The Physiology of Fitness Essay Example for Free

The Physiology of Fitness Essay What is an acute response? An acute response is an immediate response to exercise. Acute exercise will last throughout the full length of your training session. During the training session our bodies begin to respond to the exercises we are doing and begin to feel the changes within our bodies and mind due to physical strain and stress of the physical activity in lots of different ways. Musculoskeletal response Increased blood supply: the increased blood supply occurs in the body due to the increase in demand for more oxygen and this is due to the working muscles needing more oxygen and energy during exercise. With there been an increase in blood supply that means there will be greater amounts of oxygen been delivered around the body at a faster speed due to the heart pumping blood around the body at a faster pace. Increase in muscle pliability: Muscle pliability is the stretchiness of your muscles and connective tissues. When muscles become warm they become more pliable and this helps reduce the risk of an individual becoming injured during exercise and this is because the muscles contract quickly when the body is exercising. When the muscles are contracting they produce heat which then a=makes the muscle more pliable. The warmer the muscle becomes the further you can stretch it each time without the muscle becoming weakened or injured. Increased range of movement: Synovial fluid is the result of joint movement and allows joints to move without them rubbing together and causing friction. During exercise joint changes occur and this is because the synovial fluid becomes less viscous (the measure of thickness of a fluid) so therefore the range of movement at the joint will increase. Muscle fibre micro tears: When muscles are put under pressure whilst exercising tiny tears occur. These tears within the muscles cause swelling, which then puts pressure on the nerve endings which causes a lot of pain. To help strengthen the muscles and help repair the micro tears you need to rest and you can strengthen the muscles  by training. Energy systems Everything in our bodies requires energy and our body mainly needs energy to move. Energy can be generated in different ways and this is depending upon the duration or intensity of the exercise that the individual is performing. Phosphocreatine: The ATP-PC system can also been known as the alactic acid system. During exercise the ATP-PC energy system works between 1-10 seconds long it usually consists of different sport activities like: high jumpers, long jumpers, javelin and shot putters. This energy system doesn’t produce lactic acid and it works without oxygen. When the body has been doing exercise your body uses the energy source ATP. When ATP has been used within the body this energy system is the first fuel to be called upon the body to resynthesize ATP. ATP-PC utilizes Phosphatecreatine and this then allows high intensity muscle contractions. The maximum storage this energy can take up without the individual training is less than 8 seconds in duration. So this means tha t this energy system can work at a high intensity but only for a short period of time! There are ways in which Creatine phosphate (CP) can be increased within the human body and that is through training. By training levels of CP will increase by: †¢Speed training †¢Creatine loading Both of these delay the use of the lactic anaerobic system but even though it delays it still gives 15 seconds of energy stored in the body. The ATP is stored in the muscle and liver and this can produce energy quickly. Nerve impulses in the body trigger the breakdown of ATP into ADP, however for this to continue ad for the body to continue to use this energy system, the ATP must be resyntesized /rebuilt and this comes from the splitting of phosphocreatine. When the ATP is used, it is rebuilt but this will only happen as long as there is phosphocreatine available within the body. Energy is released from the phosphocreatine breaking off and from this it resynthesizes in the mitochondria and the ADP adds on the phosphate to remake ATP. The ATP-P system doesn’t provide a lot of energy but it is used for quick and powerful movements. For example: A 100m runner would use the ATP-PC system due to the fact that the athlete would need a short powerful burst of movement to be able to get off the blocks quickly. Another example  of this energy is for a shot putter. They would use this energy system because they don’t need a lot of energy for their sport, all they need is a short powerful burst of energy to be able to get a strong, powerful thrown and to be able to throw the shot-putt a long way. All these different sporting examples last up to 8-10 seconds and this is the energy production. The speed of energy production for Phosphocreatine is very fast, although the amount of ATP produced is very limited. The time it takes to recover from the ATP-PC energy system is 30 seconds up to 4 minutes. The phosphocreatine works when your body is working at high intensity at around 90-100%. The strengths of the Phosphocreatine system is because the source is stored in the muscles and liver so it can produce energy very quickly using a short burst. This means that there will be a higher force of contraction. There are also no waste products within this system. Another advantage/strength of this energy system is the recovery time. Phosphocreatine recovery time is shorter than the others which mean that the athlete can perform the event again quickly. For example: shot putters use this energy system because they have to perform 3 throws within a short period of time, so because the recovery time is between 30 seconds to 3 minutes this is the perfect energy system due to the fact they need to recover quickly to be back to their top level of performance. To improve the force of contraction, an athlete should do plyometric training and Creatine loading, this will increase powerful movements. There are some weaknesses of the Phosphocreatine system and there are: the amount of ATP that is produced is limited. It is limited due to the Creatine been stored in the muscles and liver. Although it gives a short burst of energy it only lasts around 8 seconds which is a weakness if it is used for endurance events because it wouldn’t be able to produce an explosive and powerful movement. A marathon runner wouldn’t be able to use this Phosphocreatine system because it only releases a short burst of energy of about 8 seconds whereas marathon runners need to use the aerobic energy system because the duration is unlimited and the oxygen will never run out. Lactic acid: This energy system is used without using any oxygen. It is used for activities that use large amounts of energy over a short period of time. The glycogen stored in the muscles helps the breakdown of ATP to become ADP  with no oxygen involved. Seen as though the glycogen is stored in the muscles and liver it is available quickly. This system provides ATP when ATP-PC runs out. ATP-PC lasts for a few seconds; the lactic acid system is an anaerobic energy system which allows 2-3 minutes of work. In the lactic acid system the process to produce ATP is not as fast as ATP-PC which makes contractions slower. When oxygen is not present the end product of glycolysis is lactic acid this causes the muscles to fatigue. Anaerobic glycolysis but it is then less efficient in producing ATP than aerobic glycolysis but is needed for a large burst of energy lasting a few minutes. The speed of the energy production in the Lactic acid system is fast, the energy source is glycogen. Although the amount of ATP produced is limited. Lactic acid is the by product in the production of waste products. This anaerobic energy system is used when the body is working at a moderate intensity of 60-95%. The length of time it takes to recover when the Lactic acid system has been used is 20 minutes up to 2 hours. For example: This energy system would be used for events and sports such as 800m, football and rugby games. The Lactic acid energy system would be used when an athlete is performing the 800m because you need a large burst of energy but you need it to last for a few minutes, as you do for a football, rugby game. Although all these sports would use all of the energy systems in some form. You would also use this anaerobic energy system for football/rugby game because the glycogen is stored in the muscle and liver so it is available quickly and the time is takes to recover is short so it can keep replenishing itself throughout the game. The strengths of the Lactic acid system is that is produces energy quickly, compared to the aerobic system because that releases energy slowly but lasts for an unlimited duration whereas the lactic acid system is a high intensity but for a long duration. This system lasts longer than the Phosphocreatine system because the lactic acid system uses glycogen stores which aid the resynthesis of ATP. The weaknesses of this system are that it doesn’t last as long as the aerobic energy system because the glycogen stores are limited which means it doesn’t produce energy for as long. Another disadvantage is that it causes lactic acid within the muscles which causes muscle soreness and fatigue which could lead to a drop in intensity. Aerobic: The aerobic energy system is the energy system that uses oxygen; it uses large muscle groups continuously over a period of time. Aerobic glycolysis and fatty oxidation is the resynthesis of ATP from carbohydrates and fat. Aerobic glycolysis uses glucose from the stores of the body. Glucose and oxygen are transported by the working muscles by the blood. These substances are then used by the body to produce energy. These substances are then used by the body to produce energy. This process creates the by-products carbon dioxide and water. This energy system is used for intensity exercise because this system uses oxygen. This allows unlimited duration at low intensity. Aerobic energy system uses long chain stores of glucose, this then break up further into glucose which is then used as a fuel within the body. This happens through the process of glycolysis and then in to the Krebs cycle where here it completes the oxidation of glucose, this creates more ATP. The chemical process in which it goes through, an aerobic glycolysis occurs is when Creatine Phosphate runs out, the muscles call upon the stores of glucose (glycogen). This system creates a waste product which is called Pyruvic acid. The body deals with this by the oxygen breaking down the Pyruvic acid into carbon dioxide and water. However if activity levels are too intense and not enough oxygen can be inspired then the Pyruvic acid is not broken down and it then converts into lactic acid. The speed of energy production for the aerobic energy system is slow but the amount of ATP that is produced is unlimited. This is why this energy system is used for marathon runners and cross country runners because they need to use large muscle groups within their body but for a long period of time. They also use this system because the amount of oxygen produced is unlimited so they can produce energy forever and ever without the oxygen never running out. This is why the lactic acid system and Phosphocreatine system isn’t used for long distance runners because the oxygen will run out. The advantages of the anaerobic energy system are that the system will work for an unlimited period providing glycogen stores and oxygen with high enough levels. This system lasts longer than the other two which allows an athlete to maintain high workloads for longer period of time. Another advantage would be that it can respond to high workloads much more quickly than the aerobic system meaning it can last for longer periods of time. Furthermore the anaerobic energy system is capable of supplying fuel to the cells even  when there is an oxygen deficit, which means that even when there is low oxygen the cells will still get some energy. The disadvantages of the anaerobic system are the fact that due to the lack of oxygen, glycolysis takes place which is catabolic (destructive) to the muscle cells if the process continues for too long. Lactate and hydrogen ions are produced. The lactate is used to continue energy production (current theory), while the hydrogen ions irritate the muscle tissue and chemically limit muscle contraction. This creates the burning sensation and the heavy wooden feeling in the muscles. Another disadvantage to this energy system would be that the system cannot supply energy for extended periods. When fully trained, an athlete can sustain sub anaerobic threshold intensities for 1 to 1.5 hours. Fuel resources are used up very rapidly and the body cannot synthesize fats and protein quickly enough to supply this system so, glycogen and carbohydrates must be used. Energy continuum: The term energy continuum is used to describe the types of energy system that are used during various physical activities. Energy is obtained through food and this is particularly carbohydrates and fats. This energy is transferred from the food into the proteins that are in the muscles. By the body doing this it will help determine the capacity at which intensity the body will exercise for. †¢The energy continuum is the interaction of the 3 energy systems to provide energy to resynthesize ATP. It shows the predominant system or percentage of each system dependant on their intensity and duration of the activity. †¢The most dominant energy system within our bodies would be the ATP/PC. At the beginning of exercise all three energy systems start however as we begin to exercise the PC (Phosphate Creatine) is used up meaning the lactic acid system then takes over. After this (depending on the intensity of the activity), the lactic acid/aerobic energy system is reached between 1-3 minutes. The aerobic system now becomes the main provider of energy for the ATP resynthesis. Describe the cardiovascular and respiratory systems responses to acute exercise Heart rate anticipatory response: This means the rate that the heart reaches before the start of exercise. When the body knows that it’s about to do exercise, the heart rate increases even though no exercise has  been done yet. Nerves release chemicals in the body which adjust the heart rate to increase the heart rate. This is because the body knows exercise is about to be done therefore the heart rate increases pumping more oxygenated blood to the muscles ensuring that the muscles already have a sufficient supply of oxygen for when they begin to exercise. Activity response: The activity response is very similar to the heart rate anticipatory response. At the start of exercise, nerves in the medulla detect cardiovascular activity. The nerves then send out chemical signals which increase the heart rate and the strength at which the heart is pumping. This makes more blood travel to the working muscles faster which is vital as the blood contains oxygen which ensures the muscles can carry on working. Regional blood flow is also altered to meet the requirements of blood needed at working places. This means that the working areas such as the quadriceps when running will have a higher blood flow coming to it than un-working areas such as the kidneys. Increased blood pressure: There are two types of blood pressure and these are known as systolic and diastolic. One of the body’s acute responses to exercise is to increase the blood pressure. This is because the demand for oxygenated blood to the working muscles increases therefore the amount and speed of the blood going to the working muscles must also increase. There are mechanisms in place which prevent blood pressure getting too high as this can cause a heart attack and possible death. Vasoconstriction: Vasoconstriction is when the body notices a change in temperature and begins become to come cold and it does certain things to ensure the body doesn’t lose too much heat. The blood vessels of the body constrict which means they decrease in size and this ensures as much heat as possible remains in the body as there is a smaller surface area and the blood flow decreases. Vasodilatation: Vasodilatation is one of the mechanisms the body has in place to ensure it remains at a safe temperature. It is the opposite of vasoconstriction in the way that vasodilatation functions to cool the body down. When the body notices the temperature is too high, the blood vessels will dilate which means to increase in size in an attempt to increase the blood flow. The larger surface area allows more heat to diffuse out of the body and therefore cools the body down. Control of breathing (neural): When an individual is doing exercise their body  needs more oxygen to be brought into our to the fact the demand for oxygen increases from the working muscles in order to carry on working. This is why our breathing rate increases when we are doing exercise. More oxygen is brought in by the increased breathing rate which goes on to be diffused into the blood and transported to the working muscles. If breathing rate didn’t increase, there wouldn’t be enough oxygen to meet the demands of the working muscles and exercise wouldn’t be able to take place. Control of breathing (chemical): Within our bodies there are things called chemoreceptors and these are what help to detect an imbalance of carbon dioxide levels and oxygen levels in the blood. Chemoreceptors are hydrogen ions that measure the pH levels of the blood. If something is not right, this hydrogen ion can tell the breathing rate to increase to ensure that the blood becomes neutral again. Increased tidal volume: Tidal volume is the measure of the amount of air inhaled and exhaled with each breath we take. During exercise, the tidal volume increases a significant amount. This increase happens as the breathing rate has to meet the huge demands of oxygen needed by the respiring muscles. The increase of the tidal volume allows a bigger intake of oxygen and also a bigger exhale of carbon dioxide which is produced by the working muscles and needs to be out of the body as it is a waste product.

2D Guidance in Minimally Invasive Procedures

2D Guidance in Minimally Invasive Procedures Research Strategy (a) SIGNIFICANCE: The use of two-dimensional (2D) Ultrasound (US) guidance in minimally invasive procedures such as percutaneous biopsies,1,2 pain management,3,4 abscess drainages,5 and radiofrequency ablation6 has gained popularity. These procedures all involve insertion of a needle towards a desired anatomical target. Image-guidance facilitates localization of the needle throughout the procedure, increasing accuracy, reliability and safety.7 US offers several advantages over other imaging modalities traditionally used in interventional radiology such as fluoroscopy, magnetic resonance imaging (MRI) and computed tomography (CT): It provides real-time visualization of the patients anatomy (including soft tissue and blood vessels) vis-à  -vis the needle, without exposure to ionizing radiation.8 Additionally, being portable and low cost (compared to other imaging modalities) are the added advantages of US imaging. Despite these advantages, the effectiveness of 2D US in needle guidance is highly operator dependent. In the in-plane approach, where needle shaft is parallel to the imaging plane, the needle shaft and tip should ideally be continually visible.9 However, aligning the needle shaft with the scan plane is difficult. Even when the needle is properly aligned, steep orientation (required in most procedures) of the needle with respect to the US beam causes nonaxial specular reflection of the US signal off the needle surface due to a large angle of incidence.10 In this imaging condition, the needle shaft will appear discontinuous and/or the tip will be invisible. This scenario is common with deep targets, for example during liver biopsies and epidural blocks. The challenge of needle visibility at increasing depths is compounded by attenuation of the US signal. Further, high intensity soft tissue artifacts, acoustic shadowing from dense structures such as bone and speckle noise obstruct needl e visibility. To recover needle visibility, clinicians conduct transducer manipulation by translation or rotation, movement of the needle to and fro (pump maneuver),11 stylet movement, needle rotation, and hydrolocation.12 These techniques are variable and subjective. An invisible needle can have detrimental effects on procedures, for example, reduced procedure efficacy, increase in procedure duration, neural, visceral or vascular injury, and infection. Diagnostic accuracy of 90-95% has been reported for US guided breast biopsies,13-15 and 83-95% for US guided liver biopsies.16 It is known that targeting errors due to insufficient needle tip visualization contribute to false negative results.17 In pain management, accidental intraneural injections have been reported in 17% of ultrasound-guided upper- and lower-extremity blocks, even when the procedures were conducted by expert anesthesiologists.18,19 Most of these arise because of poor needle tip localization, which makes it difficu lt to distinguish between subfascial, subepineural, or intrafascicular injections.20 In our ongoing work, we have developed an algorithm for needle enhancement and tip localization in 2D US. This, we achieved by modelling transmission of the US signal.21 We incorporated US signal modeling into an optimization problem to estimate an unknown signal transmission map, which was then used to enhance the needle shaft and tip while considering US specific signal propagation constraints.22 Automatic tip localization was achieved using spatially distributed image statistics limited to the trajectory region. However, incorrect tip localization occurred when high intensity soft tissue interfaces were present along the needle trajectory. The algorithm also required a visible portion of the shaft close to the transducer surface, necessitating proper alignment of the needle with the scan plane. We have also conducted preliminary work on needle detection and enhancement in three-dimensional (3D) US, a modality with potential to obviate the limitations of 2D US in needle guidance. Instead of the latters planar view (one slice at a time), 3D US displays volume data, allowing better visualization of anatomy and needle trajectory at all needle axis orientations. This alleviates the challenge of needle alignment in the scan plane.23 Nevertheless, needle obliquity at steep insertion angles, depth dependent attenuation, as well as acoustic shadowing, imaging artifacts and speckle remain.24,25 Needle visibility is also affected by low dimension of the needle with respect to the US volume. In fact, reported false-negative results for breast biopsies under 3D US show no improvement over those with 2D US.26,27. Consequently, 3D US has not replaced 2D US as the standard of care. To overcome the limitations, researchers have proposed computational methods for needle enhancement and local ization in 3D US. These include: Principal component analysis based on eigen-decomposition,28 the 3D Hough transform,29 the 3D Radon transform,30 parallel integration projection,31 and iterative model-fitting methods such as random sample consensus (RANSAC)32. The accuracy of these methods is affected by attenuation and high intensity artifacts. Besides, computational complexity arises from processing the large amount of volume data.33 Projection based methods fail when a good portion of the shaft is not visible and the tip intensity is low. A more robust needle localization framework based on oscillation of a stylus was recently proposed, although it fails in a single operator scenario, especially for shallow angles.34 All the mentioned methods are based on modeling B-mode image data. The current need, in interventional radiology for needle guidance, is a cost-effective, easy to use, non-radiation based real-time imaging platform with an ability of providing continuous guidance with high accuracy during needle insertion without intercepting the clinical workflow. Our long-term goal of developing a computational 3D US based imaging platform for enhancement and localization of needles is informed by this need. To address this pressing need, we hypothesize that automatic, real-time, accurate, and continuous target identification using 3D radiofrequency (RF) US data is feasible and potentially could be used to provide guidance during interventional radiology for needle insertion.Our preliminary work on modeling US signal transmission in 2D US, as well as needle detection and enhancement in 3D US, are strongly supportive that modeling the RF US signal coupled with advanced reconstruction methods will improve needle visualization and localization in 3D US. The envisaged 3D US reconstruction techniques will incorporate emerging work from machine learning and advanced beamforming to achieve needle enhancement and localization. We envision new pathways of processing and presenting US data, which should make this rich modality ubiquitous to all end-users for needle guidance in interventional radiology. The impact of the proposal will be multiplied since the developed algorithms, using open-source software platform, can also be incorporated as a stand-alone component into existing US imaging platforms. (b) INNOVATION: Previous work on needle enhancement has mostly been focused on enhancement of B-mode images. B-mode images are derived from RF data (the raw signal backscattered onto the US transducer) after several proprietary processing steps. The raw signal is known to contain more statistical information35 which is lost along the processing pipeline. Parallel integral projection in order improve needle visibility in soft tissues using 2D and 3D RF data has previously been investigated although no image visualization, needle enhancement or localization was demonstrated.36 It has been shown that the post-beamformed 2D RF signal allows for a more improved enhancement of local features in US images. 37,38 Image enhancement methods applied to RF signal have also shown to produce improved display of orientation of a biopsy needle.37,38 This study is innovative in three respects: 1) To the best of our knowledge, it is the first to investigate needle enhancement and localization from 3D pre-beamformed RF data (previous approaches were using post-beamformed RF information). 2) The utilization of machine learning approaches, such as deep learning for needle enhancement in 3D US will be a first. 3) Although this pilot will focus on validating the developed framework on pain management and liver biopsy procedures as a case study, the new mathematical and computational approaches proposed in this work will lead to developments that can easily be adopted for enhancement and localization of needles in other interventional radiology procedures. We expect that the achieved results will lead in gradual adoption of 3D US as the standard of care in problematic minimally invasive procedures where 2D US is challenged, thus improving therapeutic and diagnostic value, reducing morbidity and optimizing patient safety. (c) APPROACH: We propose to test the hypothesis that needle detection, enhancement and localization based on the raw 3D RF signal will provide a more accurate and robust platform for needle guidance than current state of the art. The basis for this hypothesis is found by precedent in the use of the RF signal for bone localization,39 and our published21,22 and unpublished work on needle enhancement and localization based on 2D/3D B-mode image data. This preliminary data is presented below. Preliminary work 1 Modeling 2D US signal transmission for Needle Shaft and Tip Enhancement When the US signal pulses are sent by the transducer into tissue, they undergo reflection, scattering, absorption and refraction. These phenomena all contribute to attenuation; the loss in intensity of the US pulses as they travel deeper into tissue. Attenuation is responsible for non-conspicuity of the needle tip and shaft at increasing depths. Previously, we have shown that modeling signal transmission in 2D US based on 2D image data, while considering depth-dependent attenuation leads to enhancement of the needle and more accurate tip localization.21 The modelling framework yields signal transmission maps, which are then used in an image-based contextual regularization process to achieve tip and shaft enhancement (Fig.1). A tip localization accuracy of mm was achieved in ex vivo tissue. However, the localization accuracy is lower when soft tissue interfaces are present along the needle trajectory, and when the needle is not properly aligned in the scan plane. In the context of th is proposal, our objective is to apply similar US signal modeling and contextual regularization, this time based on RF data. Preliminary work 2 Machine learning approaches for needle detection and enhancement in 3D US Since 3D US is multiplanar, the challenge associated with needle alignment in the scan plane is partially eliminated when it is used in needle guidance.   Nevertheless, 3D US is also affected by US signal attenuation. Previous methods proposed for needle enhancement and localization in 3D US did not address this need. In addition, most were computationally demanding because of the requirement to process the entire US volume. In this work (results submitted to 20th MICCAI conference, 2017), we have developed a learning-based method for automatic needle detection in 3D US volumes. The pixel-wise classifier generates a sub-volume containing only slices with needle information. In so doing, computational complexity on the subsequent enhancement and localization algorithms is reduced (Fig.2). The tip is automatically localized in 3D. We achieved 88% detection precision, 98% recall rate, a slice classification time of 0.06 seconds, a localization accuracy of mm, and a training time of 1 5 seconds. Figure 2. Learning based needle detection, enhancement and localization in 3D US. Top row: an example of needle detection. Here, the original volume contained 41 slices, and the classifier identified only 7 containing needle data. Bottom row: The enhancement process on the sub-volume. Left, enhanced intensity projection image. Middle, automatically localized tip (red) displayed on the relevant axial slice. The blue cross is the manually localized tip. Right, trajectory estimation indicated by the green line. Specific Aim 1. To develop RF-signal modeling algorithms for improved 3D US image reconstruction For this aim, we hypothesize that adaptive beamforming methods applied to pre-beamformed 3D RF data will enhance needle visibility and improve quality of US volumes. During the formation of an US image, the reflected US signals are received by the transducer elements at different time points due to varying signal travel distances. Beamforming on each scan line is meant to establish signal synchronism before aggregation. The conventional method of beamforming in both 2D and 3D US is delay and sum (DAS). Here, received signals are electronically delayed, followed by application of a beamformer whose weights are reliant on echo signals, leading to undesirable wide main-lobe and high side-lobe levels resulting in imaging artifacts, thus decreasing the image resolution and contrast. 40 In this architecture, the angular resolution is dependent on the length of the scan aperture and the fixed operating frequency.41 In a fixed hardware configuration, these parameters cannot be increased, hen ce resolution cannot be improved. To overcome this challenge, adaptive beamforming methods based on minimum variance42-45 and multi-beam covariance matrices46 have been proposed. Using adaptive beamformers signal detection can be maximized while minimizing the beam-width and side lobe artifacts.47,48 Recently, phase factor beamforming, where phase variations are tracked across the receive aperture domain, has been shown to improve the appearance of bone surfaces from 2D US data49. Bone features, similar to needle features, are hyper-echoic when imaged with US. Therefore, during this aim we will develop an adaptive phase-factor beamforming method in order to enhance the hyper-echoic targets such as the needle from 3D pre-beamformed RF data. Specifically, adaptive beamformer that combines ideas from Minimum Variance (MV) adaptive beamforming,50 signal regularization based on statistical information in RF data,51 and Toeplitz structure covariance matrices52 to minimize computational co mplexity will be investigated. It is expected that this reconstruction technique will adapt the data to the clinical application of needle enhancement through improving image resolution, contrast, and speckle suppression. The algorithms will be incorporated into an open source imaging platform for real-time data collection and processing.   Ã‚  Ã‚   Overall, we expect that the algorithms developed in Aim 1 will allow enhanced representation of US needle data with increased diagnostic value. The images obtained from this aim will be used as an input to the algorithms proposed in Aim2. Specific Aim 2. To develop methods for needle enhancement and tip localization in 3D US images Our working hypothesis for this aim is that learning based approaches for needle detection coupled with image reconstruction methods in 3D US will achieve improved needle enhancement and tip localization. In our previous work, we have shown that a linear learning based pixel classifier for needle data in 3D US, based on local phase based image projections, improves needle enhancement and reduces computational load.   The detector utilizes Histogram of Oriented Gradients (HOG)53 descriptors extracted from local phase projections and a linear support vector machine (SVM) baseline classifier. Recently, deep learning (convolutional neural network (CNN)) based image processing approaches have shown to produce very accurate results for segmentation of medical image data54. However, enhancement or segmentation of needles from US data using convolutional neural networks has not been investigated yet.   Therefore, for during this aim we will develop a needle enhancement and segmentation m ethod using convolutional neural networks. Needle images with various insertions angles and depths will be labeled by an expert radiologist. Our clinical collaborator Dr. Nosher and several radiologists from RWJMH will be involved during this labeling process. We will use two different datasets during the labeling process. The first data set will be retrospective US images downloaded from the Robert Wood Johnson Medical Hospital (RWJMH) database. Specific focus will be given to liver biopsy and epidural management procedures where US has been used to guide the needle insertion and biopsy procedure. The second data set will involve collecting needle US scans using ex vivo tissue samples as the imaging medium. These scans will be collected at the PIs laboratory using an open source platform US machine with 3D imaging capabilities. The collected ex vivo data will be enhanced using the beamforming methods developed in Aim 1.   Labeling process will involve manual identification of the needle tip and shaft from the two datasets. A fully convolutional neural network54 will be trained using the labeled data. The architecture of this network does not require extensive data sets in order to train the network and yields high segmentation results. Previously this approach was used for segmenting cell structures54. The output of this operation, which will be a fuzzy 3D probability map (high probability regions corresponding to needle interface), will be used as an input to our previously developed needle tip localization method. The automatically identified needle tips will be compared against the manually identified needle tips. More details about the specific clinical data collection and validation are provided in Specific Aim 3 and Protection of Human Subjects. Overall, at the end of Aim 2 we expect to have a system providing continuous real-time monitoring of needle insertion using 3D US for improved guidance in interventional radiology procedures. Specific Aim 3. To validate the developed imaging platform on clinical data To validate the algorithms developed in Aims 1-2, we plan to perform extensive validation on ex vivo and clinical data. No clinical trial will be conducted during this proposal. Our initial validation will be limited to epidural administration and liver biopsy procedures. Ex vivo data: This study will be conducted for validating Aims 1-2. US scans will be collected from two different needles: 1-) A general 17-gauge Tuohy epidural needle (Arrow International,Reading, PA, USA),   and 2-) 18-gauge biopince full core liver biopsy needle (Argon Medical devices, Athens, Texas, USA). The needles will be inserted at varying insertion angles (300−700) and depths (up to 12 cm). Ex vivo porcine, bovine, liver, kidney and chicken tissue samples will be used as the imaging medium. 3Dpre-beamformed RF data will be collected using a SonixTouch US system (Analogic Corporation, Peabody, MA, USA) equipped with the 3D phased array transducer. The US machine, provides an open-source research interface allowing for custom-made applications directly run on the machine, and the 3D transducers. The image resolution for different depth settings will vary from 0.1mm to 0.3mm. In total, we will collect 300 different 3D US scans for each tissue sample (making the total n umber equal to 1500 3D US scans). The collected scans will be enhanced using algorithms developed in Aim1. From the enhanced data, our clinical collaborators will manually identify the needle tips. Three different radiologist, with varying expertise, will be involved during the validation process in order to calculate the inter-user variability error. We will also ask the same users to repeat the needle tip identification process after two weeks to assess the intra-user variability error. The labeled data will be used in order to train the CNN proposed in Aim2. For testing the CNN algorithm, we will collect additional new 500 US scans. The manually identified needle tip locations, from the new dataset, will be compared to the automatically extracted needle tip locations obtained from the algorithms developed in Aims1-2. Euclidean distance error between the two tip locations (manual vs automated) will be calculated for quantitative validation. Clinical data: This study will involve collection of retrospective US data from patients who are enrolled for a liver biopsy or epidural administration as part of their standard of care. Women and minorities will be appropriately represented in the recruited patients. Sex or race will not play a role as an inclusion or exclusion criteria. Specific focus will be given to patients who are 21 years and older and require a liver biopsy or epidural administration. All the US data and the patient information (age, sex, height, weight, and laboratory data) will be assigned a non-identifying alpha-numeric code that will ensure that the risk of re-identification of participants from the acquired data is not possible. Additional information is included in the Protection of Human Subjects. In total, we will collect 1600 different US scans, from 400 patients. For labeling (manual tip and needle shaft localization) in order to train the CNN method developed in Aim2 we will use 1200 scans. During testing, 400 US scans, not part of the training dataset, will be used. Again expert radiologist will be involved during labeling and testing procedures for tip and shaft identification. Error calculations will involve calculating Euclidean distance between the two tip locations (manual vs automated).

Keep Blaming Canada Essay -- Music Downloads Technology Essays

Keep Blaming Canada In 1999, Shawn Fanning and his little program called Napster created quite a stir in society. Napster's software allows music listeners to open pieces of their personal hard drives to everyone using Napster, sharing whatever MP3 songs they have already downloaded or stored. At any time, thousands of people are online, sharing hundreds of thousands of songs, many of which are technically illegal to download without the permission of the copyright holders. [1] This led to a lawsuit filed by the Recording Industry Association of America, with the rock group Metallica as its frontman. In this case, several issues were brought up, one of which was the right of the creator of the music to control what happens with their intellectual property. In the United States, it was found illegal, in the form of Copyright laws, for people to download the musician’s music without permission. However, this only gave full rights of intellectual property to the creator. But this was only the ruling in the United States. Other countries have different versions of Copyright Laws with different interpretations. Copyright in Canada In Canada, the Canadian copyright law is governed by the Copyright Act, which protects original literary, artistic, musical and dramatic works. One very significant right granted to the owner of Canadian copyright in a work, is the exclusive right to reproduce the work, in any material form they choose. For example, the owner of copyright in a book has the right to stop others from making copies of the book, whether the copying is by way of a commercial printer, a photocopy machine, or by way of a computer image/text scanner. Copyright in a work may be assigned or licensed to others. All assignments and licenses of copyright must be in writing to be valid. The mere transfer of physical possession of a work does not thereby include an assignment of copyright in the work. [2] These seem similar to the Copyright laws found in the United States. It provides similar protection to literary work, artistic, music and so on. But as the times change, so too will the way the laws work. Changes to the Act On March 19, 1998, Part VIII of the Copyright Act dealing with private copying was brought up for a major change. Before that, â€Å"copying any sound recording for almost any purpose infringed copyright, although, in prac... ...;http://www.cb-cda.gc.ca/news/c19992000fs-e.html>. [3] Borland, John. â€Å"P2P downloading is legal, says Canada.† 15 December 2003. Silicon.com. 9 February 2004. . [4] O’Reilly, Tim. â€Å"Piracy is Prograssive Taxation, and Other Thoughts on the Evolution of Online Distribution.† 12 December 2002. OpenP2P.com. 9 February 2004. . [5] Reid, Shaheem and Walker, Curtis. â€Å"50 Cent Says He's Capitalizing On Arrest, Doesn't Mind Being Bootlegged.† 16 January 2003. VH1.com. 10 February 2004. . [6] King, Howard. â€Å"Why Metallica Sued Napster.† 1 May 2001. Findlaw.com 10 February 2004. . [7] Kearns, Dave. â€Å"Intellectual property: Napster and ethics,† 9 April 2001. Network World. 10 February 2004. . [8] Barlow, John Perry. March 1994. â€Å"The Economy of Ideas.† Wired. Issue 2.03. 10 February 2004 .

Working at The Bindery Essays -- Expository Process Essays

Working at The Bindery I have a dream. I have a dream about getting a doctorate degree in music. Well, to get that far, I know I must get through undergraduate school first, let alone graduate school, and so on. Last year I realized that I needed a job that paid much more than minimum wage if I was going to afford to go to college. I then heard about The Bindery from a friend in the same situation as I was. I filled out an application, went to the orientation a few weeks later, and then discovered that working there would be no ordinary job. I will now briefly explain how the factory works and then show you the "ropes" of working in my department.   Ã‚  Ã‚  Ã‚  Ã‚   There are two major departments at The Bindery: the press and the bindery. The press cuts large rolls of paper into smaller ones. The rolls of paper are trimmed down to size for books, and all words and graphics are printed here. The paper is then folded by machinery into forms (groups of pages in books). Bundles of forms are held together with a piece of wood at each end and tied with plastic string. The bundles are then loaded onto skids. After the skids are prepared, the bundles are shipped to the work-in-progress area (where you are) by fork trucks. The skids of bundles are placed in front of each pocket, where forms are placed to feed into the machine that binds the paper into books. Pockets are parts of machinery about 12-15 feet long and are at waist or stomach height. The machine takes one form from each pocket and groups them all together to make a book. It runs very quickly, and it can make thousands of books in minutes. Five lines are in th e bindery department, therefore, five books can be made at the same time.   Ã‚  Ã‚  Ã‚  Ã‚   First, I will e... ...r workstation so it will be clean for the next shift. When the journey persons say it is timeto go, grab your belongings and punch out. Get some sleep for the next day. Working at The Bindery has taught me and is still teaching me much responsibility. I have learned to manage my time well. Working afternoons is tough because I don't get home until midnight every night. Life isn't fun and games every night anymore. I also have learned to work very hard for my money to pay for my college tuition. Being there just for the summers was a taste of real life for me; not everyone gets the opportunity to live wealthy like we see in the movies. It has given me more motivation to stay in school to avoid a life-long job like this, for I don't want to labor for the rest of my life. I want to continue to live out my dream of getting my doctorate degree in music.

The World Church of the Creator :: Religion Racism White Supremacy Essays

The World Church of the Creator Free speech comes in many forms, some offensive and some non-offensive. One of the more offensive sites on the Internet is the homepage for the World Church of the Creator. This site supports an extreme white supremacist point of view whose followers, from my interpretation of the site, believe that all races, except for the white race, are inferior. The site is also extremely anti-Semitic. In short, according to the site, if someone is not white and Christian, then they are no one. First, this site has an extreme belief in white supremacy. The followers of the World Church of the Creator have an extreme belief in white supremacy. For example, the slogan of the World Church of the Creator is "Let us work together to build a whiter and brighter world!" (World Church of†¦"). Throughout the numerous pages of the site, there are many references to the superiority of the white race. Their monthly publication, "The Struggle," is dedicated to "survival, expansion, and advancement of the white race." (World Church of†¦"). They even try to explain that there is a rather large biological difference between the different races of the world. The Reverend Matt Hale goes into a detailed explanation about the biological differences between races. For example, he says that: There are only two ways people can be equal. One way is to be the same physically; the other is to be the same mentally. Considering the former first, are people the same physically? No. We have tall and short, thin and fat, young and old, White and Black, strong and weak, fast and slow, plus all sorts of mediums and in-betweens. No equality is to be seen among individuals. As to differences among races, there are many differences such as head shape and facial features, physical maturity at birth, brain formation and cranial capacity, visual and auditory acuity, body size and proportions, number of vertebrae, blood types, bone density, length of gestation period, number and distribution of sweat glands, rate of infant development of alpha brain waves, fingerprints, ability to digest milk, hair forms and distribution, odor, colorblindness, genetic diseases (such as sickle cell anemia and Tay Sachs), galvanic skin resistance, pigmentation of the skin and eyes, and susceptibility to inf ectious diseases. If there are this many physical differences, it would be silly to think that there would be no mental differences, and indeed we do find that they not only exist, but are of great significance.

Using Two Contrasting Case Studies, Discuss Management Schemes in Fragile Environments.

Using two contrasting case studies, discuss management schemes in fragile environments. A fragile environment is when there the balance between climate, soils, vegetation, animal life and people could easily be upset and the ecosystem destroyed. In order to maintain a fragile environment dynamic sustainability needs to be established. An example of a fragile environment is the Serengeti National Park and Jau National Park. The Serengeti National Park is situated in the Tropical Grassland biome. This means that it has temperatures are high throughout the year averaging at around 28OC.There are wet and dry seasons due to the movement of the ITCZ (Inter Tropical Conversion Zone). In the Serengeti there are long periods of drought during the dry season and during the wet season convectional rainfall results in heavy downpours. In the Serengeti management schemes are essential in order to maintain the ecosystem. One way that the ecosystem is maintained is through monitoring and controllin g the number of elephants and fires within the ecosystem. In the past fires and elephants have shaped the ecosystem.They both affect the vegetation within the Serengeti as they can destroy it. Elephants eat the tress and fires burn them into ash. The elephants and fires need to be controlled because if there are too many elephants or fires then the number of trees in the Serengeti will decrease but if there is not enough of them then again the ecosystem will change as they control the establishment of trees. Fire is monitored and controlled through the Park Ecology Department who ensure that there is enough fire but that they do not get out of hand.The Serengeti is also managed by having a top-down approach to management where the park authorities co-operate with the Masai (indigenous people in the Serengeti). There is a game management strategy, which means that the Masai who live around the edge of the park are able to some controlled and licensed hunting of game so they do not hu nt to much and endanger the animals there. This means that the hunting that the Masai do controls the herds, keeping them in balance with the grassland resources.Hunting can stop the tendency to overgraze the area that can arise if the number of animals grows too high. The Serengeti also uses a strategy when it comes to the use of land. In order to maintain a balance between crop production for the animals and the local people the authorities have zoned the areas so that there is enough grazing land, and enough space in areas around the park for growing crops. The Jau National Park differs from the Serengeti as it has a double maxima of rainfall.The National Park has very low annual temperature range with the temperature being between 26OC and 27OC throughout the year. The ecosystem contains three main vegetation types: dense tropical forest, seasonally flooded forest and dry shrub woodland. The Jau National Park also has management schemes in place in order to conserve the ecosyste m. Jau National Park is one of the few conservation units in the Brazilian Amazon with a management plan that is both compete and being implemented.To integrate local residents with conservation initiatives within the Park there are periodic meetings with residents to disseminate planning decisions, provide training for environmental education professionals and research on the economic valuation of natural resources. The management plan has three phases: I: protection, minimizing of impacts and integration with neighbors; II: research into and protection of biodiversity; III: specific activities. Jau National Park has a zoning plan in place with four management zones: 1.Primitive – where there is minimum intervention and maximum protection. Nothing is done to the area and it is left to have its natural vegetation and animal species. 2. Extensive use – some human activity. This is where small tribes of indigenous people are allowed to live their chosen lifestyle in the area. 3. Intensive use – already altered by humans. This is where farming is allowed. 4. Special use – the park services core – this is where hotels and buildings are with toilets etc. Using Two Contrasting Case Studies, Discuss Management Schemes in Fragile Environments. Using two contrasting case studies, discuss management schemes in fragile environments. A fragile environment is when there the balance between climate, soils, vegetation, animal life and people could easily be upset and the ecosystem destroyed. In order to maintain a fragile environment dynamic sustainability needs to be established. An example of a fragile environment is the Serengeti National Park and Jau National Park. The Serengeti National Park is situated in the Tropical Grassland biome. This means that it has temperatures are high throughout the year averaging at around 28OC.There are wet and dry seasons due to the movement of the ITCZ (Inter Tropical Conversion Zone). In the Serengeti there are long periods of drought during the dry season and during the wet season convectional rainfall results in heavy downpours. In the Serengeti management schemes are essential in order to maintain the ecosystem. One way that the ecosystem is maintained is through monitoring and controllin g the number of elephants and fires within the ecosystem. In the past fires and elephants have shaped the ecosystem.They both affect the vegetation within the Serengeti as they can destroy it. Elephants eat the tress and fires burn them into ash. The elephants and fires need to be controlled because if there are too many elephants or fires then the number of trees in the Serengeti will decrease but if there is not enough of them then again the ecosystem will change as they control the establishment of trees. Fire is monitored and controlled through the Park Ecology Department who ensure that there is enough fire but that they do not get out of hand.The Serengeti is also managed by having a top-down approach to management where the park authorities co-operate with the Masai (indigenous people in the Serengeti). There is a game management strategy, which means that the Masai who live around the edge of the park are able to some controlled and licensed hunting of game so they do not hu nt to much and endanger the animals there. This means that the hunting that the Masai do controls the herds, keeping them in balance with the grassland resources.Hunting can stop the tendency to overgraze the area that can arise if the number of animals grows too high. The Serengeti also uses a strategy when it comes to the use of land. In order to maintain a balance between crop production for the animals and the local people the authorities have zoned the areas so that there is enough grazing land, and enough space in areas around the park for growing crops. The Jau National Park differs from the Serengeti as it has a double maxima of rainfall.The National Park has very low annual temperature range with the temperature being between 26OC and 27OC throughout the year. The ecosystem contains three main vegetation types: dense tropical forest, seasonally flooded forest and dry shrub woodland. The Jau National Park also has management schemes in place in order to conserve the ecosyste m. Jau National Park is one of the few conservation units in the Brazilian Amazon with a management plan that is both compete and being implemented.To integrate local residents with conservation initiatives within the Park there are periodic meetings with residents to disseminate planning decisions, provide training for environmental education professionals and research on the economic valuation of natural resources. The management plan has three phases: I: protection, minimizing of impacts and integration with neighbors; II: research into and protection of biodiversity; III: specific activities. Jau National Park has a zoning plan in place with four management zones: 1.Primitive – where there is minimum intervention and maximum protection. Nothing is done to the area and it is left to have its natural vegetation and animal species. 2. Extensive use – some human activity. This is where small tribes of indigenous people are allowed to live their chosen lifestyle in the area. 3. Intensive use – already altered by humans. This is where farming is allowed. 4. Special use – the park services core – this is where hotels and buildings are with toilets etc.

Communication in Nursing Essay

To listen to another person is the most caring act of all. Listening and attending are by far the most important aspect of being a nurse (Burnard 1992). One of the basics of good nursing is good communication skills with patients. Being unable to communicate well with a patient immediately can destroy the nurse/patient relationship and therefore the patient may not trust the nurse (Anon 2007). The purpose of this essay is the realise the importance of communication in nursing. Without communication nurses would be unable to provide the correct care, but improving communication is a life-long developmental process (Ewles and Simnett 2005). I will draw on my personal experience from the clinical area to show how well the theory relates to the practical side of nursing and use the process recording sheet for structure and guidance. In accordance with The Nursing and Midwifery Council (2008) Code of Conduct, nurses must respect people’s right to confidentiality. Therefore for the purpose of this essay the patient discussed is referred to as Miss C., and any personal or identifiable information has also been altered so as to protect her privacy and dignity which are also enshrined in the Nursing and Midwifery Council (2008) Code of Conduct.. I asked Miss C. for explicit permission to use our interpersonal relationship in my communications essay and advised her of my obligations on my professional conduct to which I am bound by the Nursing and Midwifery Council (2008), regarding professional, moral and safe practice. Miss C., was in agreement to be involved with my assignment and on no account was her physical care at risk during this interaction. I was nearing the end of my placement in a general medical ward within a large general hospital. The ward had a variety of medical complaints including diabetes, gastrointestinal disorders, stroke and alcohol liver disease. A young 21 year old female was admitted to the ward, now known as Miss C., with an increased weight loss and she was in need of pain management. Miss C., was awaiting heart surgery, replacement hips and replacement knees at major surgical hospital in another area of the country. Her health status was poor as she suffered from rheumatoid arthritis, psoriasis, and had a congenital heart defect. Miss C’s., pain was managed with oramorph, ketamine and fentanyl patches, but these proved to have little relief. Miss C., spent the majority of time in bed due to her severe pain, and due to this she cried  out a lot. Her head was bowed and she had difficulty in making eye contact. She talked slowly and quietly and sometimes mumbled, she was also a very sad person. I thought that communication would be difficult with Miss C., as she was mostly in pain but I also believed that she would like someone to talk to but that person would need to be a good listener. It is important to remember that nurses have the duty to provide care holistically, for the whole person, not just for their physical needs but their mental and social needs too (Kenworthy et al. 2002). Miss C., liked to be washed in her bed every morning as movement for her was difficult. The bay that she was in was busy with little privacy only the curtains for seclusion. I went into wash her one morning and because of her psoriasis she needed special creams applied religiously. She spoke quietly about her illness and explained her difficulties to me. Talking about her family, her illness and when she was younger made her sad and she was crying. I felt that Miss C’s ability to communicate was linked to how she felt about herself. She was over-critical about herself and underestimat ed her abilities. This lack of self-confidence reflected her ability to communicate (Ewles and Simnett 2005). She was in so much pain, her head was bowed and she could not make eye contact. I was leaning in close to her bedside, touch was not good, her body was too sore. I tried to show empathy towards Miss C., by giving her time to talk, being patient and listening to her. Was she crying because she was in so much pain or was it because she was recalling happy memories from before she fell ill? I was desperately trying to understand how she may be feeling. According to Arnold and Boggs (2003), empathy is the ability to be sensitive to and communicate understanding of the patient’s feelings. Being compassionate is similar to being empathetic in a way that it is important to recognise that Miss C’s feelings belong to her and not to me. I was interested in Miss C’s illness, to learn more about her condition and hear about her difficulties. She was very independent and wanted to do a s much as she could by herself. Help was minimal and she only asked when she was struggling to re-position her feet. I used active listening to allow to her speak without interrupting but I paid close attention to her facial expressions and body language. Argyle (see Kenworthy et al. 2002) suggests â€Å"facial expressions provide a running commentary on emotional states†. I asked Miss C. open questions about her illness as I thought this would allow me to encourage her to talk. It also allowed Miss C to describe her experiences, feelings and understandings. â€Å"Open ended questions are used to elicit the client ‘s thoughts and perspectives without influencing the direction of an acceptable response† (Arnold and Boggs 2003 p.241). I wanted to try and take her mind off her pain as it was upsetting to see her being so unhappy, so I commented on some magazines that were lying on her table and asked her about her taste in music. This was a good subject, her eyes lit up and she smiled. We finally made eye contact. Using the semiotic school of thought, Miss C and myself were exchanging verbal and non-verbal communication in order to understand each other’s feelings. According to Kozier (2008) non-verbal communication can include the use of silence, facial expressions, touch and body posture. Miss C was keen to talk about her taste in music and became very chatty, in fact, she became sort of excited. I put some cd’s on for her to listen to and as I did this she asked me questions about my taste in music. There was now no barriers to our communication as we both shared the same taste in music. When the music was playing Miss C was in a different world, she was more relaxed. I took her hand and held it gently, her eyes were closed, she was smiling and she appeared more content. By holding her hand, I felt as though I was comforting and reassuring her. This was an indication that I really did care and that I wanted to help her. â€Å"Using touch skilfully and thoughtfully can convey that you are able to ‘be with’ your patient† (Benner 2001 p.57). Communication can be therapeutic and the music playing was not a barrier in communications, it was in fact beneficial. Therefore, it is argued that effective communication is more than delivering high quality patient-centred care; but it also allows patients to feel involved in their care, which can make a significant difference to their outlook on their treatment (Collins 2009). Reflecting back I realised that I was really quite worried about the communication difficulties I was facing during my interaction. Miss C., was a very strong willed person who knew exactly what she needed and yet she desperately wanted to be as independent as possible. I wanted her to allow me ‘in’ and for her to be comfortable with me. I am glad I eventually gained her trust and we both became more relaxed. In fact, the impact that this interaction had on our relationship was that as the days went on we became very good friends and she was very special to me. Sully and Dallas (2005), suggests  that to have an empathetic understanding of our patient’s needs we must recognise their need for comfort and we respond to this compassionately. It was important to be non-judgemental, I accepted Miss C., for who she was no matter what her circumstances were and my main concern was to care for her in a professional and beneficial way and in a manner that she preferred. Putting the interaction into perspective, I originally found Miss C very demanding, always calling out and constantly pressing the call buzzer. Some staff were very reluctant to go to her because her personal care was very time consuming. It was time consuming but it was because she was in a lot of pain. Surely this was a barrier to communication as so me staff did not take the time to listen to what Miss C required and as health promoters, we need to develop skills of effective listening so that we can help people to talk and express their needs and feelings (Ewles and Simnett 2005). From recording and analysing my interactions I have learned to accept people for who they are as each of us have had different experiences throughout life and these experiences make us who we are. It was also important to acknowledge Miss C’s point of view, her emotions and thoughts without judgement as being aware of these helped to appreciate her perspective and needs (Silverman et al. 2005). I have also learned to be a good listener and an active listener. Ewles and Simnett (2005) suggest that this means taking note of the non-verbal communication as well as the spoken words. It is important to maintain eye contact, observe the body language, listen properly and pick up on non-verbal signs as well as verbal signs. The environment is important too, along with being sensitive, honest and compassionate (Anon 2007). Collins (2007) argues that judgemental attitudes can stand in the way of getting to know your patient and that labels attached to individuals such as ‘demented’ can act as a language barrier. Effective nursing requires us to be assertive, responsible and to help our patients achieve the best possible health status (Balzer Riley 2008). In conclusi on, the key points that have been discussed in this essay are that of the importance of communicating in nursing and how nurses can improve their communication skills and maintain their effectiveness. We must provide holistic care for our patients and the goal is to listen to the whole person and provide them with empathetic understanding. Another key point is that we must be non judgemental no matter what the patient’s circumstances are. Overall communication during this interaction was positive, therapeutic and helped to build a relationship. This essay has shown how personal experience from the clinical area relates the theory to the practical side of nursing and how it is imperative that communication is clear, understandable, appropriate and effective. 1819 words Read more: http://www.ukessays.com/essays/nursing/communication-in-nursing-nursing-essay.php#ixzz2fJpdOIza