Why This School Secondary Essay Sample Is So Popular?

Why This School Secondary Essay Sample Is So Popular?The purpose of this article is to assist you in answering the question why this school secondary essay sample is so useful and so famous. As a matter of fact, you will learn more about how to compose your essay without difficulty. However, we will also inform you about some other things that you will need to know before you start writing your own college essay.In the first place, you should learn how to write a complete cover letter and a short introduction paragraph. Next, you should read the information in 'Why this school secondary essay sample' and then write a basic essay. Thus, you will be familiar with some of the fundamental elements of college essays.Before you begin writing, you should have a definite final goal in mind. This may be to write a college essay or it may be to gain entrance to an institute. Whatever the reason, you should identify what is the end of your career in a suitable manner.The purpose of this article is to provide you with a basic idea about the benefits of using a school secondary essay sample for preparing your own college essay. In any case, you will find out how the college essay paper can be of immense help to you in attaining your primary objective.From here, you should understand that the essay samples are very helpful for students who are not very good in composing their own essays. The main reason behind this fact is that they are usually prepared by people who possess considerable writing skills. Therefore, these people spend little time for doing research and analysis.You should make sure that the college paper that you write reflects your personality. You should make sure that it is appealing to your peers. You should make sure that it is an inspiration to your fellow students. The goal of this article is to help you in attaining the status of writing a good scholarship application. If you keep this in mind, you will not face any difficulty in getting hold of schola rships from prestigious institutions and agencies.

Jacob Riis Jane Addams Essay on Progressive Era free essay sample

At the turn of the twentieth century the press received a great amount of credit for the success of the Progressive movement. Notable muckrakers Jane Addams and Jacob Riis showed determination towards there being a change; each made sure to use their abilities to aid in not only a social way, but ask economically and politically, even to this day what theyve done has made a massive impact. A native of Denmark, Jacob Riis moved to the US in 1870 to pursue work. Riis worked as a police reporter, but eventually became a social reformer. He fought to eliminate the devastating slum-like conditions that were present in New York Citys Lower East Side. With the use of his book â€Å"How the Other Half Lives†, Riis was able to open many of the wealthy residences eyes to how immigrants and the less fortunate lives during that era. Riis himself endured similar conditions when he first made the transition to the states; he struggled with being jobless, hungry and homeless, many nights he copes with thoughts of suicide. We will write a custom essay sample on Jacob Riis Jane Addams Essay on Progressive Era or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Three years later he acquired a job as a journalist working for the New York association. How the Other Half Lives† targeted the minds of wealthy citizens as a way to get them to open their eyes to what others just like them were forced to live through. Jacob Riis pointed out that there were single family dwellings that shared side walls with other houses, they were called tenements and were overcrowded and unsanitary. Riis was able to project a very concerned tone and empathize with the people that suffered with poverty, because he too himself knows what it feels like to experience such an battle. Through the pictures in his book, America was able to see what little the government did to help financially unstable people. Riis along with fellow muckrakers Upton Sinclair with his novel â€Å"The Jungle† which shed light on disgusting and filthy conditions surrounding the production of food products, and Jane Addams who created the Hull Houses as a way to provide shelter and better living conditions for Americans. Overall Riis was able to accomplish exactly what he wanted, he was capable of successfully accomplishing what he set out to, with the recognition â€Å"How the Other Half Lives† received, people from the outside looking in changed their mindsets and actually improve the living conditions for the poor, which at that time lessened the amount of diseases spreading. An advocate for immigrants, the poor and women, at the age of twenty-nine Jane Addams established the Hull House in 1889, which opened its doors to European immigrants, providing them with food and shelter. Located in Chicago, the Hull House became the first settlement house in the United States. As a social reformer, Addams became the spokesperson for organized labors and was determined to eliminate poverty. Through her writing and speeches, Addams left a lasting impression on the nation during the Progressive Era; her commitment to immigrant communities, and similar to Jacob Riis in her work with wanting to improve slum-like communities, helped change the way people view impoverished living conditions and the things they do to improve them. Both Jane Addams and Jacob Riis did whatever they sought necessary to improve the conditions that immigrants encountered during the progressive era, both worked and successfully got the wealthy and the government to make a change in the way they handled those specific situations, all while influencing modern day. With what theyve done during the Progressive Era, Jane Addams and Jacob Riis made a key point in empathizing the needs for more jobs for immigrants and shelters for the less fortunate.

Merriam-Websters 2018 Words of the Year

Merriam-Websters 2018 Words of the Year Merriam-Webster’s 2018 Words of the Year Merriam-Webster’s 2018 Words of the Year By Mark Nichol Toward the end of every calendar year, Merriam-Webster, like other major dictionaries, shares a list of the words most frequently searched for on its website. As usual, this search traffic is largely driven by public discourse, as people look up words they see and hear in the media and in conversations, seeking to learn definitions of unfamiliar words or to clarify for themselves the meanings of words they know (or think they know). This post discusses Merriam-Webster’s Word of the Year for 2018 and ten runners-up. The Word of the Year, justice, was newsworthy in several contexts. The primary sense is that of administration or maintenance of fairness and lawfulness, and increasing concern about social justice has brought the concept, and the term that represents it, to the forefront in our society. But justice is a job title as well as a concept, referring to a judge on a national or state supreme court or similar body, and the controversy over confirmation of Brett Kavanaugh as an associate justice of the US Supreme Court also led people to check the definition. (The senior member of a supreme court is often titled â€Å"chief justice,† while the others are designated â€Å"associate justices.†) Finally, on a more trivial note, the Justice League is a team of superheroes created for DC Comics and appearing in various media, including a film released late last year. The runners-up include nationalism, which has figured prominently in the media as the concept gains traction throughout the world, including in the United States, where President Donald Trump recently unabashedly identified himself as a nationalist. However, he, like many people, appears to be unclear on the concept: Nationalism is often conflated with patriotism. However, while the latter term refers to pride in one’s country, nationalism denotes loyalty to a nation at the expense of international (and intranational) harmony. Nationalism is closely associated with fascism, a political philosophy that incorporates dictatorial control and centralization of authority and brutal suppression of individuals and groups deemed undesirable or resistant to fascists’ goals. In summary, to be called a nationalist is decidedly not a compliment, and to call oneself a nationalist does not invite compliments. Pansexual, incorporating a Greek prefix meaning â€Å"all,† refers to a conception of gender identity and sexual orientation as something that occurs along a spectrum, rejecting the idea of binary categorization. Lodestar, originally denoting Polaris, the North Pole Star, which for millennia has served as a navigational aid, now refers more broadly to a guide, inspiration, or model. (Lode is a Middle English word meaning â€Å"course† or â€Å"way; it’s seen also in the context of mining: A lode is a deposit of ore.) The term had a vogue this year after it was used in an anonymous op-ed in the New York Times purportedly written by a senior Trump administration official. Because Vice President Mike Pence is known to use the fairly obscure term, some people suspected him of being the author. An epiphany is an appearance or manifestation, but the term is most commonly employed to refer to a realization or revelation. Its popularity as a search term early this year likely resulted from the Christian holiday by that name, which on January 6 commemorates the visit of the Magi, or Three Wise Men, to where the infant Jesus lay; it derives from the Greek verb epiphainein, meaning â€Å"manifest.† Feckless, used by a television commentator to criticize Ivanka Trump for, in her role as adviser to her father, failing to criticize the Trump administration’s immigration policies, employs the root feck, of Scottish origin, meaning â€Å"value† or â€Å"worth.† Essentially, it is a rare synonym for worthless. Laurel, the word for a tree whose foliage was used to crown victors in athletic events in ancient Greece, became a hot search term when a debate erupted online about which of two words was being enunciated in an online dictionary’s pronunciation sound file. By extension of its original definition, the term came to apply to the celebratory object itself and to figurative honors; one idiom based on the term is â€Å"rest on (one’s) laurels,† which alludes to someone who, upon achieving an honor, refrains from attempting feats that bring further recognition. (Usage generally pertains to one who does not rest on one’s laurels, meaning that person does seek other honors.) Pissant was frequently looked up after a radio personality described a famous football player’s daughter with the word, which is a derogatory dialectal term formed from piss and ant. (This word is not to be confused with puissant, a rare term meaning â€Å"powerful† and etymologically related to power and potent. All three words derive from the Latin term posse, meaning â€Å"able,† which survives in English as the term for a group deputized to pursue a fugitive or, more loosely, to denote one’s entourage.) The death this year of Aretha Franklin, best known for her rousing rendition of the song â€Å"Respect,† prompted look-ups of that word, which literally means â€Å"look back.† (The second syllable of that word, meaning â€Å"look,† is also the root of spectacle, spectator, inspect, suspect, and so on.) Maverick is a term often applied to the late John McCain, a US senator and presidential aspirant, for his frequent opposition to party-line politics. The word, describing someone who often acts without regard for group or party loyalty, derives from the surname of a gentleman who, after taking a small herd of cattle as payment for a debt, neglected to brand them, rendering them vulnerable to appropriation by other ranchers, who rounded them up on the open range and applied their own brands to the livestock. Since then, the word has been a synonym for independent, though â€Å"stolen from a careless owner† would be a more appropriate association. The death of Marvel Comics mogul Stan Lee this year resulted in references to excelsior, the word with which Lee typically signed off in the columns he wrote for his company’s comic books. Though the primary meaning of the word is mundane- it was a trademark for a brand of wood shavings used as protective packing material and later a generic term- its origin is the Latin word meaning â€Å"higher†; excel, excellent, and so on are related. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:What Is Irony? (With Examples)Precedent vs. PrecedenceQuiet or Quite?

The Function of a Blank Assignment Example | Topics and Well Written Essays - 1000 words - 8

The Function of a Blank - Assignment Example It is mostly used for volatile organic compounds that are present in low concentrations. Condensation in the cold trap allows preconcentration for easier analysis by GC/MS Absorption is the process of transferring a gaseous compound into a uniform distribution in a liquid or solid. Involves the collection of gases, liquids, or solutes on a solid surface. Usually a porous solid is used, this provides vast surface areas. The less volatile a compound is, the more gas will be adsorbed. The quantity of a gaseous pollutant adsorbed by a given quantity of adsorbent depends on Concentration in the air over the surface, Surface area of the adsorbent, Temperature, Other gases competing for adsorption sites and Properties of the adsorbate. These methods of sampling are also referred to as the wet collection system. The most contaminated soil is used for the study of possible decontamination or to study the degradation or persistence of the contaminant. Some contamination may also favor other forms of land use than others. Therefore contaminated soil may be used for other applications Bio fixation involves the incorporation of particular organic material to aid in the regulation of other compounds that could be contaminants. An example of bio fixers is root nodules of some plants that fix nitrogen in the soil. Most organic compounds degrade naturally and are, therefore, termed to be biodegradable. Therefore, the concentration of biodegradable material reduces with time. ä ¸â‚¬ Foodborne illness is an illness that is carried in the food, to those who eat it. It may be caused by microorganisms such as Bacteria multiplying rapidly in food that is high in protein, such as meat or poultry. Temperature danger zones are temperatures that promote bacterial growth. The temperature danger zone ranges from between 40 ºF to 140 ºF (4.4 ºC-60 ºC) and food should be contained in these temperatures for more than four hours

Mondrian's Mathematical principles art Speech or Presentation

Mondrian's Mathematical principles art - Speech or Presentation Example Mondrian employed the very simple geometrical shapes and primary colors for expressing reality, nature and logic. His perspective of viewing things was different. He considered that it is possible to construct any kind of shape as long as there is a basic geometric one. Same is the case with colors; any color can be made by a combination of two or more of the primary colors, red, blue and yellow. A very common element of Mondrian’s art is the Golden Rectangle. This comes under the basic shapes and it has been used repeatedly by Mondrian in his artwork. The following compositions were created using the primary colors and both contain several golden rectangles. The first one was painted in 1942 and the second, right one in 1926 (Mondrian 1937–42). Basically, through his work Mondrian wanted â€Å"to achieve harmony through the balance of the relationships between lines, colors and planes. But only in the clearest and strongest way† (Ruhrberg, et al. 2000,

M Night Shyamalan, The Auteur

M Night Shyamalan, The Auteur Manoj Nelliyattu Shyamalan, also known as M. Night Shyamalan, has earned his auteur reputation with film productions such as The Sixth Sense, Unbreakable, and The Signs. He is best known for his ability to create a thoroughly fictional world with unbelievable events. His style is well expressed through his films as most of his stories focus on the supernatural. In this respect, M. Night Shyamalan can easily manipulate the viewers expectations by means of mystical elements and breath-taking twists. It can be claimed that M. Night Shyamalan achieved great success with the 1999 blockbuster The Sixth Sense. The narrative structure of the film could be interpreted from two quite different perspectives. On the one hand, Malcolm Crowe is a therapist, who survives a gun shot accident and tries to help Cole Sear, a very young and emotionally introverted child. On the other hand, the intensity that surrounds the entire storyline of the film keeps the audience in suspense until the very end of the film, only to reveal that Crowe has been murdered. The story then takes the viewers to a completely different dimension where Crowes presence is not physical anymore as he roams as a ghost who can be only seen by Cole. Indeed, it is the young Cole who helps Malcolm understand that he must leave his mournful life in the past and move on to take his place among the living dead. This is a perfect example of how M. Night Shyamalan can play games with the viewers expectations. After the enormous success of The Sixth Sense, M. Night Shyamalan came back with yet another thrilling film. Unbreakable is a story about ordinary people looking for the supernatural element or event in their lives. Bruce Willis plays the role of David Dunn who soon realizes he has extraordinary abilities as a consequence of a train accident. The relationship between him and his son, Joseph, emphasizes the supernatural element as Joseph is very excited with the idea that his father is a real-life superhero. Meanwhile, David and his wife, Audrey, have to patch up their crumbling marriage. Sooner rather than later, however, David meets Elijah Price, played by Samuel Jackson, who thinks and actually tries to persuade David that he is, indeed, a modern-day superhero. M. Night Shyamalan succeeds again in surprising the audience with another twist in the plot. The viewers realize at the end of the film that Elijah has staged numerous disasters for the past few years in order for him to dis cover his superhero ego. Signs is yet another example of a typically characteristic M. Night Shyamalan film. Released in 2002, the film explores a different supernatural phenomenon of crop circles that soon turn out to be an alien invasion of global scale. Hollywood star Mel Gibson plays Graham Hess who is a former minister of religion. As soon as his wife dies in a car accident, Graham decides to renounce his faith in God. Throughout the film Hess recollects the moment he saw his wife for the very last time and M. Night Shyamalan does an excellent job in conveying hidden messages. She talks to him about their family and asks him to tell his brother and a former baseball player, Merrill, to swing away. Although the audience might consider his wifes death as a random event in the storyline, the films finale proves that it is not a random event after all. In the scene where the alien is about to kill his son, Graham again remembers the moment when he talked to his wife just before she died. It is then when she somehow managed to foresee the future and tell her beloved how to save his family. Therefore, M. Night Shyamalan presents a story of Grahams moral passage from his loss in divine providence to the conditions that help him regain his religious faith again. It can be even argued that Graham is quite similar to Bruce Williss hero in The Sixth Sense who realizes and reconciles with the fact that he is a living dead man. In addition, the three films share common storyline features and themes. In The Sixth Sense Crowe cannot realize that he is a ghost at first and in Unbreakable David does not believe in his extraordinary powers and learns from both his son and Elijah that he must embrace them and the responsibility that comes with them. In Unbreakable Shyamalan presents the human side of mystical events in quite a new theme where he illustrates how different people could be. In Signs Mel Gibsons character questions his faith in God until the moment he understands that the circumstances, which helped him save his family, are not accidental. Indeed, Signs bears a strong religious theme as Graham Hess is being subjected to a test of what he actually believes in and why he believes it. Aided by a recovered memory and a supernatural occurrence, Graham Hess manages to revive his relationship with God. Moreover, not only does M. Night Shyamalan pay attention to the storyline of all his films, but he also focuses on interpersonal relations. It is important to note the strong relationship between Malcolm and Cole in The Sixth Sense, David and his son, Joseph, in Unbreakable, and Graham with both his children Morgan and Bo as well as Merrill, his younger brother, with his nephew and niece in Signs. Another aspect of Shyamalans work is the slow pace he imposes on the plot. Malcolm Crowe gradually realizes that he is dead in The Sixth Sense, David Dunn gradually sees the superhuman powers he has in Unbreakable, and Graham Hess gradually rediscovers his faith in God in Signs. Also, in order to establish a stronger and more emotional bond between the characters, M. Night Shyamalan uses long-take shots. For example, in The Sixth Sense shot duration helps him build up emotional bonds not only between Malcolm and Cole, but also between Cole and his mother, Lynn. There is also a scene in Unbreakable which is a direct analogue of the one that takes place at the Anniversary Dinner restaurant in The Sixth Sense with the only exception being that David Dunn is alive as he talks to his wife, Audrey. M. Night Shyamalan makes use of long-take shots in Signs as well in order to highlight the strong bond between the two brothers. The most notable scene between Graham and Merrill is when they sit before the television set and have a long conversation, in which they share their feelings on the menacing alien invasion and what they believe in. In such dialogue scenes, long-take shots are the most appropriate visual tool that can cast further emphasis on the strong emotion al relationships between the main characters. Furthermore, M. Night Shyamalan uses windows, glasses, and mirrors as symbols for thematic reasons in most of his films. For example, in The Sixth Sense M. Night Shyamalan uses parallel shots and mirror images in a scene where Crowes wife, Anna, appears with a bottle of wine in order for them to celebrate the award Malcolm has earned for outstanding achievement in the field of child therapy. Sitting in front of the fireplace they both enjoy it sarcastically, with their images reflected in the glass encased award. Shyamalan shows Malcolm and Anna as well as their reflection in parallel shots with purpose. The mirror image symbolizes the false reality of Crowe who soon becomes a reflection of himself. In addition, reflected images take an important part in Signs as well. When Graham comes out of the basement he feels as if the aliens are already gone and everything is back to normal again. It is then when he goes to take the television set from the closet and rolls it back into the living room. The timing of the scene turns into a powerful device as it only contributes to the one of the most horrifying scenes in the film. As soon as Graham brings the television set, there is a loud sound which emphasizes the terrifying revelation of an alien reflected on the screen. Similar shots are used in Unbreakable where the image of Elijah Price is reflected on a television set as well. It is an indisputable fact that the great amount of themes Shyamalan uses in his films reflects his directing style. Last but not least, M. Night Shyamalan makes cameo appearances in most of his films. In The Sixth Sense he appears as a doctor and shows in quite a short scene with Coles mother. In Unbreakable he plays the role of a drug dealer at a stadium, while in Signs Shyamalan takes a bigger part as Ray Reddy, the veterinarian who is accused guilty by Graham of the car accident, in which Grahams wife died. In conclusion, the slow pace and mystical elements constitute the plots as well as the characters in M. Night Shyamalans films. This is what appears to be his signature and philosophy in terms of directing and this is why I think his films are far better than the ordinary horror and thriller films. In addition to the visual technique, he also makes use of mystical elements and ambiguity in such a way that the storyline can easily get under the viewers skin and hold suspension until the very end.

CT scan of abdomen and pelvis without contrast Essay

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen. PELVIS: Good quality, non contrasted actual CT examination of the pelvis with coronal reconstructions. Prostate, seminal vesicles and urinary bladder appeared WNL. The bowels seen on the study appeared WNL, except for inflammatory changes of the appendix and seccum with acute appendicitis. Osseous structures of the pelvis appeared in tract with evidence of bilateral hip degenerative changes. IMPRESSION: 1. Findings consistent with acute appendicitis 2. Degenerative changes of the hips Paula Reddy NN:EF D: T: DISCHAGE SUMMARY Patient Name: Benjamin Engelhart Patient ID: 112592DOB: 10/05/Age: 46Sex: M Date of Admission: 11/14/2012 Date of Discharge: 11/17/2012 Admitting Physician: Benard Kester, MD General Surgery Procedures Performed: Laparoscopic appendectomy with placement of RLQ drain on 11/14/2012 Complications: None. Discharge Diagnosis: Acute subapperative appendectomy perforated. DIAGNOSTIC/IMAGING LABS: Lab results at the time of admission showed a WBC count of 13. CT scan done in the ED revealed an acute appendicitis with fleggon. HOSPITAL COURSE: The 46 years old Caucasian gentleman presented to the ED with a 3 day history of abdominal pain, however in the last 24 hours and it has________ migrated to the RLQ with anneorixia, guarding and elevated WBC of 13 and CT scan consistent with appendicitis. The patient was taken to the operating room where he underwent a laparoscopic appendectomy that revealed appendix perforation and phlegmon. The appendix was removed in toto with an intact stable line. A drain was placed in the RLQ due to the fleggmonous material. Patient did well over the successive 2-3 days postoperatively with resumption of an oral diet having past flatus with having bowel movement with minimal drain output. However his WBC lowered to 6. His drain has been left intact. Patient is being discharged on the post operative day 3 on a 1 week course of PO gentamicin. The drain left in place. The drain will be removed in my office on 11/24/2012 if the drain output is minimal. Patient is on a PO diet. He was given a script for both antibiotics and PO narcotics. (Continued) PLAN: Post operative visit in my office in 1 week for evaluation and possible removal of JP drain. No heavy lifting for 4 weeks following surgery. Patient is to complete his full course of post operative antibiotics. DISCHAGE SUMMARY Patient is to report to the ED or my office earlier if any redness or foul smelling drainage out of the wound sit. Any swelling, fever, pain or any other concerns. Patient and his wife verbalized the understanding of the agreement with the above plan. Bernard Kester CC: Max Hirsch, MD D:11/14/2012 T:11/14/2012 HISTORY AND PHYSICAL EXAMINATION Patient Name: Benjamin Engelhart Patient ID: 112592DOB: 10/05Age: 46 Date of Admission: 11/14/2012 Emergency Room Physician: Alex McClure, MD Admission Diagnosis: Acute Appendicitis HISTORY OF PRESENT ILLNESS: 46 year old gentlemen with past medical history significant only for degenerative disease with bilateral degenerative disease of the hips. Secondary to arthritis. Presents to the Emergency room after having had 3 days of abdomen pain. It usually started 3 days ago and was generalized vague abdomen complaint. Earlier this morning the pain localized and radiated to the RLQ. He had some nausea without amesis. He was able to tolerate PO earlier around 6am. but now denies having an appetite. Patient had very small bowel movement earlier this morning that was not normal for him. He has not passes has the morning. ‘he is voiding well. Denies fevers, chills or night sweats. The pain is localized to the RLQ without radiation at this point. He has never had a colonoscopy. PAST MEDICAL HISTORY: Significant for arthritis of bilateral hips seen by Dr. Hersch. PAST SURGICAL HISTORY: Negative MEDICATIONS: Piroxicam for degenerative joint disease of bilateral hips ALLERGIES: No known drug allergies SOCIAL HISTORY: Patient admits alcohol ingestion nightly and on weekends. Denies tobacco use and illicit drug us. He is married. FAMILY HISTORY: No history of cancer or inflammatory bowel disease in his family. REVIEW OF SYSTEMS;;12 point ROS was preformed and is negative except noted in above HIP, PMH and PSH. Careful attention was paid to endocrine, integumentary, pulmonary, renal and neurological exam PHYSICAL EXAMINATION: Vital Signs. TEMPERATURE: 101.0, Blood Pressure- 127/179, Heart Rate-129, Respirations- 185, Weight-215. Situations 96% on room air. Pain Scale- 8/10. HEENT-Normal cephalic, atrumatic pupils equally round and reactive to light. Extra ocular motions intact. ORAL: Shows oral pharynx clear but slightly dry mucosal membranes. TMS: Clear. NECK: Supple, No thrangegally or JVD. No cervical,  subclavicular, axilarry or lingual lymphinalpathy. HEART: Regular rate and rhythm. No thrills or murmur heard. LUNGS: Clear to aspiration bilateral. ABDOMEN: Obese with minimal bowel sounds, slightly distended there is RLQ tenderness with guarding and pinpoint rebound. Positive _____. Actuator signs with negative psoas side. RECTAL: No evidence of blood or masses. PROSTATE: WNL. EXTREMITIES: No clubbing, cyanosis, clots or edmea. 1+ pedal pulses bilaterally. NUERO: Cranial nerves 2-12 grossly intact. DIAGNOSTIC DATA: WBC was 13.4, Hemoglobin and hematocrit 15.4 and 45.8, platelets 206 with 89% shift. Sodium 133, Potassium 3.7,Chorlide 99, Bicarbonate 24, BUM and Creatine 18 and 1.1, Lukeuos 146, adermin 4.3, total bulliru,1.7, remainder of the LFTs is WNL. Urinary analysis reveals trace keytones with 100 mg per decimeter with small amount of blood. CT scan was preformed revealing evidence of acute appendicitis with parasitical inflammation as well as facilitation of appendix inflammation and haziness in aperparacifiacal dilation. There is evidence of degenerative joint disease in bilateral hips on the cat scan as well. ASSESTMENT PLAN: This 46 year old Caucasian gentleman has signs and symptoms and radiographical findings consistent with acute appendicitis without evidence of abscesses. The plan is to take him to the operating room for laproscopic possible open appendectomy and possible large bowel dissection should the case resisitated. Plan was discussed with patient with his wife. Risk, benefits and alternatives were discussed. There was no barriers to communication and all questions were answered appropatily The patient understands the plan and desires to proceed . (Continued) The plan was discussed with Dr. Keslerof general surgery who agrees and will take patient to operating room . Alex McClure, MD D:11/14/2012 T:11/14/2012 PATHOLOGY REPORT Patient Name: Benjamin Engelhart Patient ID: 112592 DOB: 10/05/Age: 46Sex: M Pathology Report No: 10-S-9044 Date of Surgery: 11/14/2012 Attending Physician: Bernard Kester, MD general surgery Preoperative Diagnosis: Acute appendicitis Postoperative Diagnosis: Necrotizing acute appendicitis Specimen Received: Appendix other than incidental Date specimen received: 11/14/2012 Date reported: 11/16/2012 CLINICAL HISTORY: Acute appendicitis. GROSS DESCRIPTION: The specimen was received in formily? With patient name, ID and appendix. It consist of a appendix measuring 6 x1.5Ãâ€"1.5 cm there periepdesial fat attached to it measuring 6Ãâ€"4 by1 cm. The cirrosal surface is hemmoraggric. Upon opening the appendix there is percudent exudates material. The wall thickness measures 0.3cm. Representive sections are present is 1 cassettes. MICROSCOPIC DESCRIPTION: Performed MICROSCOPIC DIAGNOSIS: Appendix appendectomy, Necrotizing acute appendicitis. ICD Diagnosis Code: 540.9 (Continued) CPT Code: 8-88304 Georgia Tamato,MD ALW: D:11/14/2012 T:11/14/2012 OPERTIVE REPORT Patient Name: Benjamin Engelhart Patient ID: 112592DOB: 10/05Age: 46Sex: M Date of Admission: 11/14/2012 Date of Procedure: 11/14/2012 Admitting Physician: Bernard Kester, MD General Surgery Surgeon: Bernard Kester, Assistant: Jason Wangner, PAC Circulating nurse: Jimmy Dale Jet, RN Preoperative diagnosis: Acute appendicitis. Post operative diagnosis: Perforated appendicitis. Operative Procedure: 1: Laparoscopic Appendectomy. 2: Placement of RLQ drain. Anesthesia: General endotracheal. Specimen Removed: 1 Necrotic appendix. IV Fluids: 1700 crystalloid. Estimated Blood Loss: 10mL. Urine Output: 300mL. Complications: None. INDICATIONS: This gentleman is a 46 year old Caucasian male that came in with a 3 day history of abdominal pain, however the pain worsened after 24 hours to the RLQ and caused a significant amount of anorixia. He presented to the ER department. CT scan to abdominals and pelvis showed acute appendicitis. Labs showed WBC at 13. Laparoscopic appendectomy procedure was explained along with the risk, benefits and possible complications. Patient voiced his desire to proceed. Patient was started on preoperative gentamicin. DESCRIPTION OF PROCEDURE: Patient was ID’d times 2 in the pre op holding area. A final timeout was held in the nursing area, anesthesia and surgical service during in which the patient ID was confirmed and the surgical site was initialed. He was given preoperative antibiotics. He was taken back to the OR and placed in the supine position. General endotracheal anesthesia was induced. SEDs were placed on his lower extremities. His Left arm was tucked to the side. Foley Catheter was placed. His abdomen was shaved and prepped with betadine solution, and draped in the usual standard fashion. A small semicircular umbilical incision was made to the subcutaneous tissue down to the fascia. And was gasped at either side and was incised. Kelly clamped was easily inserted. Stay sutures made a _____on either side the Hasson trocar was placed and pneumoperitoneum was easily  achieved. 10 mL port was placed in Left abdomen and a 5 mL was placed in the LLQ. Inspection of RLQ showed a significant amount of adhesions and the small bowel trying to wall off perforated appendix. Milky purulent exudates was noted in surrounding area. The small bowel was carefully peeled off the RLQ side wall. Fibrous exudate the vermiform appendix was identified. It was neurotic perforated in appearance The cecum was mobilized by taking down the lateral attachments laterally. The adhesions of the terminal illium through the pelvis were significant, attempts at this time were not made to free them. There was no evidence of obstruction. The base of the appendix was Identified and dissected and lifted free. Stapler loaded with___ was used to transect the base______however again inflammation extended to the level of the cecum. Though the cecum itself was also inflamed. The remainder of the mesoappendix was divided with a Endo GIA loaded with a _____. Appendix was placed into a endo catch bag was brought out through the umbilical cord site and sent to pathology for routine processing. Inspection of the RLQ and the area was irrigated coupsuley, there was no further evidence of purulent exudate. The appendicualr stump remained and doesn’t appear to be inflamed. However____wasn’t bl eeding. There was some fibrous exudate in the area. Consequently I felt like we had 2 options, we either perform a right epicolodectomy, given the intent of the adhesions in the pelvis would likely require a laparotomy or place a drain with antibiotics possibly controlling the fistula until the inflammation resolves. But hopefully it will heal on its own spontatensouly. Consequently we placed a19 French round Blake drain in the RLQ and brought it out through the LLQ in the 5mm port site. It was secured to the skin using a micro suture. Nuenopartiumeum was then desufflated the fascia of the umbilical port site was closed using a 2,o vicro that had been previously placed. All wounds were enthsitized using 1/2% marking solution and was coupsley irrigated. Skin edges approximated using 4 or monocro. The wounds were dressed with beatdine spray and steri strips. Drain sponge was placed around the drain, Foley catheter was removed. The patient was awakened, exubated then taken to recovery PAR in stable condition. Having tolerated the procedu re well. No complications were observed. DISPOSISTION: 1: The patient will be transferred to the floor. 2: He will be kept at least overnight. 3: He will be taught drain care. 4: He will go home with the drain on place. 5: He may require a fistulagram in the future. Benard Kester, MD D:11/14/2012 T:11/14/2012