The Kawasaki disease

The Kawasaki disease Kawasaki disease is an intense systemic paediatric vasculitis disease that is seen commonly in childhood. Kawasaki disease is one of the most common heart diseases. It is the inflammatory disorder but the aetiology of Kawasasaki disease is unknown. It first appeared in 1967 by report of Tomisaku Kawasaki who was a Japanese paediatrician. He also called Kawasaki disease as mucocutaneous lymph node syndrome. There is no diagnostic test; therefore, doctors are using the clinical criteria that were proposed by Dr. Kawasaki 45 years ago to diagnose the Kawasaki disease. There are many different diagnosis of Kawasaki disease such as viral infections, genetic predisposition or environmental factors. Many research proposed that Kawasaki disease is an infectious disease that may be caused by Epstein-Barr virus, measles, adenovirus, enterovirus. However, there is no confirmed evidence. Usually, KD can found more in Japanese society but it keep spread to western countries and the incidence of K D in western countries are increase dramatically. There are typical symptoms that can be seen in KD such as rash, edema, and mucosal membrane changes. But there are more symptoms that are involved which are not typically found from every KD patients. Therefore, it is hard to diagnosis patients if they have KD or not. The treatment of KD is different depends on if patients are complete or incomplete KD and also, the susceptibility of IVIG will make treatment different along patients. The etiology is not certain but there are several researches shown that KD is caused by infectious agents, genetic factors, or immune system disorder. Current knowledge on the subject   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several symptoms that can be found in patients with Kawasaki disease. When patients have more than 5 days of fever for more than 38C and have more than 4 symptoms such as bilateral nonexudative conjunctival injection, polymorphous exanthem, nonvesicular rash, strawberry tongue, edema of hands and feet, bilateral non-suppurative cervical lymphadenopathy, and mucosal membrane changes, patients will diagnosis as KD. Kawasaki disease can be divided into complete Kawasaki disease and incomplete or atypical Kawasaki disease depending on the number of symptom that are present in the patient. When patients have more than four symptoms or have developed coronary artery abnormality, patients will be diagnosed as complete Kawasaki disease. In contrast, patients who have less than four of the diagnostic criteria and still develop coronary artery abnormality is diagnosed as atypical or incomplete KD. Because of the cause of Kawasaki disease is unknown, di agnosis of Kawasaki disease in infants are very challenging. Kawasaki disease can be divided into three phases. First, from one week to two weeks from onset is called acute phase. Typical symptoms are highly febrile, irritable and the fever approaches more than 39 Celsius. Oral changes occurs and also rash can be found in perineal area. Secondly, from two to eight weeks from onset is called subacute phase. In this phase, fever start to decrease slowly and the perineal area, soles, and periungual areas start to peel off. Lastly, from months to years from onset, it is called convalescent phase. In this phase, laboratory value gets normal but there may be severe consequences. For example, patients who had aneurysms may continuously have, for rest of their life, persistent cardiac dysfunction, or myocardial infarction.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Coronary artery aneurysm can be highly found in incomplete Kawasaki disease patients. It is defined as coronary dilatation that the diameter of coronary vessel gets enlarged 1.5 folds. It can be diagnosed by angiographically and it is similar to patients with coronary artery disease. The end-diastolic pressure, end-diastolic volume, and ejection fraction levels are not normal and the left ventricular contraction is not normal. The coronary artery aneurysms are mostly caused by atherosclerosis.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several associated symptoms that can be seen in Kawasaki patients. Diarrhea and abdominal pain and patients may develop arthritis. Also, myocardial dysfunction can be found in early phase of Kawasaki disease such as pancarditis which is the inflammation of all three layers of heart. Another symptom is periarteritis nodosa which is disease in connective tissue that is blocked by nodules in arteries thereby causing blood to not circulate properly. When Kawasaki disease shows periarteritis nodosa, other symptoms cannot be found.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Kawasaki disease can be diagnosis by physical exam but also it can be diagnose by laboratory exam and imaging technique. First, complete blood count test should be performed to look at the amount of white blood cell in blood. Complete blood count is the calculation of white blood cells, red blood cells, and platelet. The number of white blood cell increased to more than 15,000. Also, the erythrocyte sedimentation rate and C-reactive protein increase. After 2 weeks from onset of disease, the platelets level dramatically increases up to 1 to 2*106. There are other abnormalities such as sterile pyuria, increases of hepatic transaminases, hypoalbuminemia. In patients who have KD will have higher level of transaminase than normal person. Also, they will have higher level of ALAT and GGT than other patients who have other febrile diseases. When ALAT level increases, it will lead to coronary artery disease. Research proposed that almost 50% of incomplete KD p atients had pyuria in bladder urine. Pyuria can cause different diseases depends on where it is. When pyuria is in bladder, it can cause tubulointerstitial nephritis but when it is in voided urine, it will cause urethral inflammation. Another symptom to diagnosis incomplete KD is to look at acute anterior uveitis after the onset. Patients who have anterior uveitis do not have pain, photophobia, nor visual impairment. By using ophthalmological evaluation, it can detect if patients have different disease which have similar symptoms with anterior uveitis. One of the research in 2006 showed that there were 40% of KD patients had hyponatromia. It is caused by incorrect hormone secretion by cerebral vasculitis, dehydration, or tubular dysfuction. It is hard to diagnosis KD since there is no diagnosis test. To treat incomplete KD, the principle clinical criteria should be renewed in order not to miss out some patients who did not have principle symptoms. By missing out patients will develo p severe other diseases and will not be able to give proper treatments.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  KD also can be found out by using imaging technique. At acute phase, chest x-ray or echocardiography (ECG) are used to look at heart problem. Patients may develop coronary artery abnormalities in acute phase and this can be showed by ECG. When patients are very severe, heart specialists sometimes use single photon emission computed tomography to look into bloodstream of patients. SPECT will provide an image in 3D by using gamma rays. Epidemiology Kawasaki disease is new disease that is predominantly found among Asian children1,2,3. It was first found in Japan by Dr.Kawasaki in 1961. In early 1970s, Pathologist Eunice Larson and Benjamin Landing at Los Angeles recognized it as a new disease. Still today, there is no evidence of how Kawasaki disease emerged but some researchers proposed that Kawasaki disease emerged from Japan and spread to Western countries through Hawaii after World War II. Kawasaki disease was nationwide epidemics but now it is more likely a regional outbreak. The mean annual incidence rate is different in variety of countries and districts3. There are 90 to 112 per 100,000 in Japan, 8.0 to 47.7 per 100000 in US, and 3.6 to 3.7 per 100000 in the United Kingdom and Australia for children who are less than 5 years old. Research in China indicates that the incidence rate is 18.2 to 18.6 per 1000003. The statistics shows that Japan predominantly has highest incidence rate among Asian. Kawasaki disease can be fou nd commonly in males than females and the reoccurrence rate is less than 1%3. The incidence of Kawasaki disease has been increasing annually. In 2000, the incidence rate was 73.7 per 100000 but in 2002, the number of occurrence increased to 95.5 per 1000003. There are relationships between season and occurrence of Kawasaki disease3. But there are variations among different countries. From Japanese reports, there were more patients in winter but in American data shows that patients will develop KD more in the spring and winter. For female the occurrence appeared to be high in March, and highest in July. For boys, the highest occurrence rate was in May and the lowest occurrence rate was in February. As the research indicated, the season and climates have relationship with the susceptibility to Kawasaki disease3. Genetics   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Patients with Kawasaki disease may develop coronary artery abnormalities (CAAs) if patients are not treated early. Usually patients are treated with high amounts of intravenous gamma-globulin (IVGG) as well as aspirin which are used to reduce the possibility of developing CAAs2. However, 10-20% of Kawasaki patients do not response to induced intravenous gamma-globulin. Coronary artery abnormality will develop more frequently to patients who are not responding well to IVGG than patients who respond well to IVGG. Recent research reported that matrix metalloproteinase-9 (MMP-9) is involved in formation of CAA in acute phase of Kawasaki disease patients2. From research, the level of MMP-9 in serum who have Kawasaki disease have much higher than serum from children who does not have KD and patients who have other kinds of febrile diseases2. Using MMP-9 inhibitors might prevent the formation of CAA. However, MMP-9 inhibitors are not used clinically. MMP-9 is endopeptidase that depends on zinc that has zinc at the active site. MMP-9 have major role in tissue remodelling of extracellular membrane (ECM) 2. It can be seen in cardiac remodelling after myocardial infarction, plaque destabilization of atherosclerotic lesion. The mechanism of angiotensin-converting enzyme (ACE) inhibitors is involve with the bind zinc to the active site and stabilize by hydrogen bonds and hydrophobic interactions in the active site. The ACE inhibitor can inhibit the activity of MMP-9 and MMP-2, which have major role in neointimal formation and angiogenesis. The effect of the ACE inhibitor on MMP-9 can be measure by using captopril to the enzyme2. Involvement of the immune system From the studies by Satoshi Sato, Kawasaki disease is commonly found from patients who are younger than 5 years old1. The average age of occurrence of this disease is 2 years. Kawasaki disease does not occur frequently from children who is less than 6 months and can hardly find patients who are less than 3 months1. Kawasaki disease usually does not occur for adults who have immunity to common infectious disease. This result explains that children are more susceptible to Kawasaki disease because they might not produced antibodies to common infectious viruses, and bacteria1. Mannose bind lectin (MBL) is an important component of the innate immunity and is a reactant for hepatic origin which can bind to multiple lectin domains1. MBL has very important role in complement activation and opsonization. Complement activation refers to as the biochemical activity that helps to get rid of pathogen from animal and opsonization have similar activity to complement activation that plays role of pa thogens to get rid of the organism by ingestion and destruction by phagocyte1. It is usually found in bacterial cells, fungus cells, and viruses. It has repeating pattern of mannose and N-acetylglucosamine sugar. There are three single polymorphisms in chromosome 10 for MBL gene at codon 52 (CGT to TCT), codon 54 (GGC to GAC), and codon 57 (GGA to GAA). This mutation will lead to reduction of the level of MBL concentration but polymorphism of the promoter region of MBL will lead to increase the level of MBL concentration in the serum1. When the base changes from glycine to aspartic acid in codon 54, it will distract the interaction between MBL and MBL-associated serine protease. The interaction between MBL and MBL-associated serine protease defend against infection when patients are young. But when patients become older, the interaction of these two molecules will not have impact on the innate immunity1. Because, the patients will develop the mature lymphocytes and immunoglobulins a nd they will engulf the invaded pathogen. Therefore, this research proposes the susceptibility of the Kawasaki disease will be influenced by the MBL polymorphism1. Children who have Kawasaki disease develop endothelial dysfuntion in early phase after onset of disease and this will caused by the production of nitric oxide (NO)5. As described earlier, the primary innate immune system is very important feature for Kawasaki disease. Tumour necrosis factor alpha, IL-1, 6, 8, monocyte, chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) will be activated to produce cytokine storm5. After cytokines are produced, it will release iNOS (inducible nitric oxide synthase) in neutrophils, endothelial cells, and smooth muscle cells. Nitric oxide is produced by two enzymes which are endothelial NOS and iNOS5. Recent research found out that patients who developed Kawasaki disease have higher level of iNOS concentration in neutrophils in acute phase. Also, children have high level of nitric oxide metabolites such as NOx, NO3-, and NO2-. After production of Nitric Oxide, it will react with Reactive Oxygen Species (ROS) to give more bi ochemical reactions. This will be measured by new device called fluorescent indicators5. There are new devices used to measure the concentration of NO and ROS. First, Hydroxyphenyl fluorescence (HPF) was used to measure the concentration of ROS. Another device is called Diaminofluorescin-Flu Diacetate (DAF-FM DA) which is used to measure the concentration of intracellular Nitric Oxide5.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are significant evidences that the production of ROS and NO by neutrophils were much higher in Kawasaki disease patients in compare to people who have non-KD febrile children or non-febrile children5. By treating with IVIG, NO level will decrease. But, the production of NO can be beneficial or harmful. Usually, NO is cytotoxic but sometimes, it can protect cells from toxic materials. NO may react with hydroxyl radicals to produce much higher toxicity. To control the influence of NO, the duration, the amount of NO synthesis should be controlled. Therefore, in acute phase of Kawasaki disease, NO and ROS is highly produced and will cause damage to endothelial cells5. Treatment and future research   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  When patients are diagnosis as complete or incomplete KD, treatment should be induced right away. Because when patients have more than 10 days of fever will develop CAA. Major treatment that doctors use to treat KD is intravenous immunoglobulin (IVIG). Intravenous immuglobulin induced into bloodstream which contains immunoglobulin antibody G that is brought from other control blood donors. IVIG is still a major recommended treatment but some patients do not response to this treatment. The effects of IVIG last for 2 weeks up to 3 months. The typical amount of IVIG is a dose of 1000mg per kg of patients bodyweight. High amount of IVIG with aspirin will reduce the rate of coronary artery abnormalities (CAA) which includes coronary artery dilatation or aneurysms from 20% to 3 to 5%. Also, depends of patients, IVIG can also used with acetylsalicylic acid to treat KD.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There is one example about the incorrect treatment will cause severe disease. When IVIG was induced, patients could not cure coronary artery lesion. When patients induced with corticosteroid, they developed more coronary artery lesion3. There are two therapies which are antiinflammatory and antithrombotic therapy which are to treat Kawasaki disease instead of using IVIG. In antiinflammatory therapy, methylprenisolone, prednisone, prednisolone, and infliximab are used to treat Kawasaki disease. For antithrombotic therapy, Aspirin, heparin, warfarin, exoxaparin, tissue plasminogen activator, clopidogrel, and abciximab are used. Recently, infliximab proved by US Food and Drug administration to cure not only Crohn disease but also used to treat Kawasaki disease patients. It was not used at all in 2001 but today, the administration of infliximab usage increased up to 2.3% of total number of therapies used. It became favourable because of two reasons. First, it only administer to patients only one time. Secondly, by not using infliximab more than once, it reduce the complication as seen in other therapies which are used more than once. Infliximab is an antibody to tumour necrosis factor alpha, and cytokine in inflammatory response. It binds to tumour necrosis factor alpha and blocks the T-cell receptors to block the biochemical cascade. It will decrease the coronary artery abnormalities in patients who developed Kawasaki disease in early acute phase. To treat KD much better way, there should be more research. First, there should be more laboratory and echocardiographic data. Second, more development of clinical criteria and symptoms should be proposed. Even today, there is no perfect evidence that can explain the cause of KD; therefore, there should be more research on genetic factors by looking at KD patients family. Lastly, after treatment of KD in childhood, complication may be developed after several decades and there is not much information about complication. Therefore, by monitoring and keep in touch with KD patients are good way to find out more about complication after initial treatment. References Sato, S., H. Kawashima, Y. Kashiwagi, T. Fujioka, K Takekuma, and A. Hoshika. 2009. Association of mannose-binding lectin gene polymorphisms with Kawasaki disease in the Japanese. I. Jour. R. Dis. 12:307-310. Inoue, N., S. Takai, D. Jin, K. Okumura, N. Okamura, M. Kajiura, S. Yoshikawa, N. Kawamura, H. Tamai, M. Miyazaki. 2010. Effect of angiotensin-converting enzyme inhibitor on matrix metalloproteinase-9 activity in patients with Kawasaki disease. Clinica Chimica Acta. 411:267-269. Huang, G.Y., Ma, X.J., Huang, M., Chen, S.B., Huang, M.R., Gui, Y.H., Ning, S.B., Zhang, T.H., Du, Z.D., Yanagawa H., and Kawasaki T. 2006. Epidemiologic Pictures of Kawasaki disease in Shanghai from 1998 through 2002. Journal of Epidemiology. 16:No. 1. Yeo, Y.K., Kim, T.Y., Ha, K.S., Jang, G.Y., Lee, J.H., Lee, K.C., Son, C.S., and Lee, J.W. 2009. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr. 168:157-162. Yoshimura, K., Tatsumi, K., Iharada, A., Tsuji, S., Tateiwa, A., Teraguchi, T., Ogino, H., Kaneko, K. 2009. Increased nitric oxide production by neutrophils in early stage of Kawasaki disease. Eur J Pediatr. 168:1037-1041 Perrin, L., Letierce, A., Guitton, C., Tran, T.A., Lambert, V., Kone-Paut, I. 2009. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine. 76:481-485. Son, M.B.F., Gauvreau, K., Ma, L., Baker, A.L., Sundel, R.P., Fulton, D.R., Newburger, J.W. 2009. Treatment of Kawasaki Disease: Anlaysis of 27 US Pediatric Hospitals From 2001 to 2006. Pediatrics. 124:1-8. Ugi, J., Lepper, P.M., Witschi, M., Maier, V., Geiser, T., Ott, S.R. Nonresolving pneumonia and rash in an adult: pulmonary involvements in Kwasakis disease. EUROPEAN RESPIRATORY JOURNAL. 35:452-454. Climaz, R., Sundel R. 2009. Atypical and incomplete Kawasaki disease. Best Practice Research Clinical Rheumatology. 23 (5):689-697.

Living Life

[pic] ENC 1101 – 1591 English Composition Semester: Spring 2013 Instructor: Ms. Nancy Fletcher Campus: Sanford/Lake Mary Building: UP Room: 3205 English Office phone: 407-708-2060 Email: [email  protected] edu Days: Monday evening Hours: 6:30 – 9:15pm Credit hours: 3 Prerequisite: College Prep reading and writing requirements must be fulfilled Textbooks: Lunsford, Everything's An Argument with Readings, 5th ed. Kirszner & Mandell, The Brief Wadsworth Handbook, 7th ed.Tensen, Research Strategies for a Digital Age, 4th ed. Course Description: This is a course in the process of expository writing. Students will read essays and compose papers that are unified, organized, logically developed and supported, clearly stated, and well- focused. Research techniques are introduced and incorporated into at least one composition. This course partially satisfies the writing requirement—6,000 words (S. B. E. 6A-10. 30). Students must pass the core assignments with a ‘C' or better. Course Objectives: Upon completion of this course, the student will be able to †¢ demonstrate competence in written standard English usage, punctuation, sentence structure, paragraphing, and other fundamentals of writing †¢ develop effective essays determined by purpose and audience †¢ demonstrate awareness of writing as a dynamic process ith rough drafts, substantive revisions, proofreading, and editing †¢ recognize, incorporate, and combine patterns of exposition/rhetorical modes †¢ use critical and original thinking in course assignments †¢ employ field and library research in the creation of at least one essay, and document using parenthetic MLA format †¢ employ the use of computers for word processing and/or researching all essays Core Assignments: In order to pass ENC1101, students must pass all core assignments with a grade equivalent to a ‘C' or better. Two in-class timed writings patterned after the CLAST essay †¢ An expository essay. †¢ An argumentative essay. †¢ A library research project on a subject assigned by the instructor (minimum 5 pages) that demonstrates: researching, note-taking & drafting; producing a works cited page (5-entry minimum); documenting research using MLA style; formatting using MLA style; editing and proofreading ENC1101 Documentation Exam – score is not included in final grade.Students are required to pass the ENC 1101 Documentation Exam with a score of 70% or higher, or they will be required to retake the exam in the Make-Up Testing Center before receiving a final grade for the course. College Plagiarism Statement: As a member of the Seminole State College community, a student is expected to be honest in all of his or her academic coursework and activities. Academic dishonesty such as cheating of any kind on examinations, course assignments, or projects; plagiarism, representation; and the unauthorized possession of examinations or other course-relat ed materials is prohibited.Plagiarism is unacceptable to the College community. Academic work submitted by students is assumed to be the result of their own thought, research, or self-expression. When students borrow ides, wording, or organization from another source, they are expected to acknowledge that fact in an appropriate manner. Plagiarism is the deliberate use and appropriation of another's work without identifying the source and trying to pass off such work as the student's own. Any student who fails to give full credit for ideas or materials taken from another has plagiarized.Any student who shares his or her work for the purpose of cheating on class assignments or tests or who helps another to cheat or plagiarize is subject to the same penalties as the student who commits the act. When cheating or plagiarism has occurred, the instructor may take academic actions ranging from denial of credit for or assigning a grade of ‘F' for the course. The student may also be sub ject to further sanctions such as disciplinary probation, suspension, or dismissal from the college.Attendance: check College Catalog online. To summarize: any student who misses more than 10% of the classes can be withdrawn from the course without notice. Requests for an excused absence made after the fact must document an emergency that the student could not anticipate or prevent. Late arrivals (more than 5 minutes) are recorded as an absence and will not be overlooked, since they disrupt the learning process of the other students. Students who leave before the end of the class will be marked absent for that class.A student who has to be absent because of jury duty or court-mandated appearance needs to contact the instructor in advance of the absence in order that a plan for making up work missed can be made. When observance of religious holidays of students' religious faith interferes with attendance in class, students are required to notify the instructor in advance of such abse nces. Students are held responsible for material covered during their absences, with reasonable time provided to complete make-up assignments. Seminole State College believes that regular attendance in the classroom is necessary for student success in college.Throughout the semester, quizzes are given to evaluate the student's understanding of class material and enhance the student's grade. Because these quizzes are given in an attempt to encourage attendance, no make-up tests are given regardless of the reason for the student's absence. Withdrawals: The last day to withdraw from class is March 19, 2013. After that date, the student will be given a grade for the course. Grades: All assignments will be evaluated on the basis of a numerical scale 100 – 90A 89 – 80B 79 – 70C 69 – 60D 59 – 0FYour final grade will be determined as follows: In class CORE essay #110% In class CORE essay #210% Memoir CORE essay10% Argumentative CORE essay15% Research CORE essay25% Final Exam5% Group Projects5% Class Participation5% Quizzes10% Blogs5% Class Policies: This course will be presented on Sakai, an online course management system. All written assignments are subject to review by turnitin. com, a plagiarism evaluator. Students will be allowed one opportunity per assignment to revise and resubmit failing CORE assignments except in cases of intentional plagiarism.All resubmissions are due 1 week (7 days) from the due date of the original essay. All out of class assignments submitted by the student must be typed. Any student found to be texting or answering cell phone messages during class will be asked to leave the class. Repeated instances of audible signals from such devices that occur during class are disruptive of the learning process and will be grounds for expulsion of the student from the class for the day that the infraction occurs. No laptop computers in the classroom unless the instructor gives special permission.Seminole State Colle ge believes that regular attendance in the classroom is necessary for student success in college. Throughout the semester, quizzes are given to evaluate the student's understanding of class material and enhance the student's grade. Because these quizzes are given in an attempt to encourage attendance, no make-up tests are given regardless of the reason for the student's absence. Should emergency conditions (storms, flooding, etc. ) occur, please contact the College – not the instructor – to see if classes have been cancelled. CalendarThis is a tentative schedule that may be changed by the instructor 1/7 Class Discussion Welcome to the class! Reading of the syllabus Sakai introduction MLA formatting for essays Diagnostic essay Memoir CORE essay assigned – Sakai – Module 1 Homework to be completed for the next class Complete the Sakai tutorial Send me an email from your school email account – go to http://www. seminolestate. edu/livemail/ The library can help you if you can't unlock your account Read Wadsworth page 3 – 7 Purpose & Audience and 57 – 65 Paragraphs and 72 – 75 Introductions and ConclusionsRead Tensen 5 – 17 Topics and 169 – 175 MLA formatting for essays Choose a topic for the Memoir CORE essay Read â€Å"Writing dialogue† in Sakai Module 1 ——————————————————————————————————– 1/14 Class Discussion Memoir CORE essay topics approved Purpose & Audience Unity & Coherence Examples of Student Memoirs – Sakai – Module 1 Introductions and Conclusions Writing and using dialogue effectively Blogging Homework to be completed for the next class Read Wadsworth 23 – 24 Topics and 48 – 52 Titles & EditingRead Writing Dia logue & Punctuating Dialogue Sakai – Module 1 Read In class CORE Essay Hints – Sakai – Module 4 In class CORE essay #1 will be given in the next class. Laptops are encouraged but not required for the next class Don't forget to blog! ———————————————————————————————————— 1/21 Martin Luther King day – School closed ************************************************************************ 1/28 Class Discussion Blog #1 due in Sakai Group fiction project assigned Group meetings Picking a TitleEditing your essay Academic Success Center & Smarthinking In class Essay Hints In Class CORE Essay #1 today Homework to be completed for the next class Submit your Memoir in Assignments in Sakai by midnight 2/4 Read Developing a Thesis – Module 2 – Sakai Read Topic Sentences – Module 2 – Sakai Read Wadsworth 211 – 219 Plagiarism Practice the Overall Exam Review in ENC 1101 Documentation Tool – under Tests & Quizzes – Sakai Don't forget to blog! ———————————————————————————————————— 2/4 Class DiscussionReview of submission process – Sakai – Assignments Memoir CORE essay due in Sakai – Assignments Argumentative CORE essay assigned Plagiarism Researching databases – demonstration Thesis statements Topic sentences Homework to be completed for the next class Read Wadsworth 32 Outline and 90 Opposing Argument Read Acknowledging the Opposing Argument – Sakai Module 2 Write a thesis statement for your essay – counts as a quiz grade – must be submitted in Sakai by midnight on 2/10 – bring a copy to class Everything's an Argument 32 – 35, also 53 – 67 Ethos 69 – 93 Logos 39 – 50 PathosPractice the Overall Exam Review in ENC 1101 Documentation Tool – under Tests & Quizzes – Sakai Don't forget to blog! ———————————————————————————————————— 2/11 Class Discussion Blog # 2 due in Sakai Thesis Workshop Ethos, pathos, logos Recognizing the opposition Group 1 Fiction Project/Presentation due in Sakai – Wiki by class time Homework to be completed for the next class Laptops are encouraged but not required for the next class Review Hints for in class essays R ead Introductions and Conclusions Sakai – Module 2Read Everything's an Argument 32 – 35 Write a paragraph recognizing the opposition – quiz grade – must be submitted in Sakai by midnight on 2/17 – bring a copy to class Write a pathos paragraph for your essay – quiz grade – must be submitted in Sakai by midnight on 2/17 – bring a copy to class Practice the Overall Exam Review in ENC 1101 Documentation Tool – under Tests & Quizzes – Sakai Don't forget to blog! ———————————————————————————————————— 2/18 Class Discussion In Class CORE essay #2 today Recognizing the Opposition WorkshopPathos Workshop Introductions and conclusions Outlining the essay Homework to be complete d for the next class Don't forget to blog! Write an introduction for your essay – quiz grade – must be submitted in Sakai by midnight on 2/24 – bring a copy to class Write a conclusion for your essay – quiz grade – must be submitted in Sakai by midnight on 2/24 – bring a copy to class Practice the Overall Exam Review in ENC 1101 Documentation Tool – under Tests & Quizzes – Sakai ———————————————————————————————————— 2/25 Class DiscussionBlog #3 due Introduction Workshop Conclusion Workshop Group 2 Fiction Project/Presentation due in Sakai – Wiki by classtime Researching databases – Reprise Turnitin. com Homework to be completed for the next class Read Everything's an Argument 172 – 205 Practice the Overall Exam Review in ENC 1101 Documentation Tool – under Tests & Quizzes – Sakai Don't forget to blog! ———————————————————————————————————— 3/3 – 3/9 Spring Break – college closed ************************************************************************ 3/11Class Discussion Blog #4 due Classic, Rogerian and Toulmin Arguments Group 3 Fiction Project/Presentation due in Sakai – Wiki by class time Homework to be completed for the next class MLA Documentation Exam next class – open book – bring a pencil Practice the Overall Exam Review in ENC 1101 Documentation Tool – under Tests & Quizzes – Sakai Laptops are recommended but not required for the next class ———————————————————————————————————— 3/18 Class Discussion Library day – grade conferences available Make up in class CORE essays todayMLA Documentation Exam – open book – bring a pencil Homework to be completed for the next class Create a works cited for your argumentative essay and bring to class Prepare presentation of your group's argument Don't forget to blog! ———————————————————————————————————— 3/19 Last day to withdraw from class —â⠂¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€ 3/25 Class Discussion Works Cited Workshop Blog #5 due Group 4 Fiction Project/Presentation due in Sakai – Wiki by class timeHomework to be completed for the next class Argumentative CORE essay due 4/1 in Sakai – Assignments Don't forget to blog! ———————————————————————————————————— 4/1 Class Discussion Argumentative CORE Essay due in Sakai – Assignments Research CORE Essay Assigned Homework to be completed for the next class Write a thesis s tatement for your essay – counts as quiz grade – must be submitted in Sakai by midnight on 4/7 – bring a copy to class Don't forget to blog! —————————————————————————— —————————– 4/8 Class Discussion Thesis Workshop for the Research CORE Essay Outlining your Essay Blog #6 due Group 5 Fiction Project/Presentation due in Sakai – Wiki by classtime Homework to be completed for the next class Write an outline for your essay – counts as quiz grade – must be submitted in Sakai by midnight on 4/14 Read Help With Annotated Bibliography – Sakai – Module 3 Read Tensen 81 – 88 Read Summary – Module 3 – Sakai Don't forget to blog! —————â €”—————————————————————————————— 4/15 Class DiscussionOutline Workshop Annotated Bibliography Summarizing – in class quiz Evaluating resources Primary and secondary resources – interviews Homework to be completed for the next class Write your Annotated Bibliography and submit in Sakai by midnight on 4/22 – quiz grade Read Wadsworth 154 – 163 Read Tensen 103 – 111 Don't forget to blog! ———————————————————————————————————— 4/22 Class Discussion Group Research Project Annotated Bibliography Wor kshop Research CORE Essay due in Sakai – Assignments Blog #7 Review for the final exam

College Board Sat Essay Samples - an in Depth Anaylsis on What Works and What Doesnt

College Board Sat Essay Samples - an in Depth Anaylsis on What Works and What Doesn't New Step by Step Roadmap for College Board Sat Essay Samples To make things worse, university bookstores typically only buy back the latest edition. The foundation doesn't fund projects to directly enhance the lives of poor individuals, but it has spent a good deal, through efforts such as these, to enhance their attitudes. This may not appear to be a lot, but it is a new trend in higher education. Think of how much you'll save. This strategy is clearly helpful, but it is essential for students to have lots of practice. It allows students to solve the problem numericallyfirst, which makes it easier to then identify the proper equations in the answer choices. The Basics of College Board Sat Essay Samples This group could include an SSD coordinator. Treat every section as though it matters. This is my second favourite portion of the HMR program. Our unique and extremely specialised writing services are here in order to help you compose a waiver letter that will enhance your chances at getting the waiver you will need. My very first job as a reporter for a little newspaper proved to be a direct consequence of my internship. If you've already graduated from college or university and are trying to find a fantastic job, you want to get a persuasive resume to impress your future employer. You may be surprised to understand the worldwide education process isn't untouched by corrupt school officials. We're logging into an identical dashboard. You will discover that there are several modest changes and a bunch of further activities that may be found in the supplemental material. I don't need the info returned to my kid's custodial parent. In the event you weren't searching for it, you may have missed the Additional Information provided at the base of the webpage specializing in testing policy. If you're reading this report , you most likely want to excel on the SAT essay. So far as essay structure goes, a 4 or 5 paragraph essay based on the number of points you are going to want to argue is a superb start. The essay provides you with an opportunity to reveal how effectively you're able to read and comprehend a passage and compose an essay analyzing the passage. Nowadays it's very difficult to locate a trustworthy essay writing service. Because the new SAT is not the same test from the old SAT, it isn't feasible to perfectly compare both test scores. SAT is a significant exam you must take if you're seeking admission in a college overseas. Likewise PSAT 10 is intended for sophomores. You are able to take SAT subjects on at least one of these days. In case you haven't completed testing still, you should budget 610 months. Even though they are definitely conscious of the lengthy road ahead of them, they have to continue to push forward so as to make waves and adjust the system from its existing state. It's well worth noting this site adjustment is the newest in a string policy changes implemented by Penn in the region of standardized testing. The rapid weight loss really helps you keep motivated, since you find the results quickly. This essay will end up being 300 to 600 words, so in the event you pick solid examples and make sure that you are very clear in your explanations of things, it won't really hard t o reach. An anecdote is a brief story about a true individual or event. Only it ought to be a more vigorous and inclusive type of gratitude than that which is being urged on us now. You need to be kidding me!! I walk through the entire thing below. There are many other amazing reasons to go. Characteristics of College Board Sat Essay Samples The price of textbooks shouldn't be a tremendous issue to us, but it is. Providentially, the web has more than enough free material to achieve this. Expensive textbooks affect more than only the most important thing. We've written a whole lot of detailed guides to make sure that you do. There's so much stuff we need to fret about in college, states Tower. If your kid is not using their accommodations, they need to commence doing so immediately. It is possible to also cancel a check if it's lost. In voice-over, Ali states, The terrific mystery. Even though the College Board officially states that testing has to be within 5 decades of the application, they're more likely to approve more recent testing. J ust understand what a horrible organization you're. Describe the extensive testing and techniques used to reach the diagnosis.

Essay on A Good Samaritan Law is Never a Good Idea

A Good Samaritan Law is Never a Good Idea Less than one year ago, the largest television audience since the series finale of M*A *S*H tuned in to watch the last episode of Seinfeld As the nation watched, Jerry, Elaine, George, and Kramer said farewell with the arrest, trial, and conviction of violating a Good Samaritan law. While this made for a hilarious television show, this law itself seems to both contradict its essence as well as violate the right to freedom of choice of a citizen. The Good Samaritan law, which requires a bystander to provide aid to those who are in harm’s way if there is no apparent immediate danger to the bystander, encroaches upon the rights of a citizen. This law is an inexcusable violation of American†¦show more content†¦By requiring a person to act as opposed to merely limiting the actions, the law itself violates freedom of choice. Since the person himself is not intruding upon anyone’s rights, it is that person’s prerogative to not act, no matter how morally objectionable this act may be. In fact, the extreme case of someone not providing aid has indeed occurred. In Septem- ber in Las Vegas, a nineteen-year-old raped and murdered a seven-year-old girl in a casino bathroom while a friend stayed outside, knowing the other man was raping her. Since there is no Good Samaritan law in Nevada, the friend is now attending college a free man. Most people probably wonder how someone could hear a little girl’s screams and turn instead to the laughter and lights of the casino. They ask, if he could not bring himself to step in, how can he sleep at night now, knowing he caused the pain and death of an innocent child? He did not touch her or aid the rapist in any way. According to the letter of the law he can not be prosecuted for any criminal act. Despite the lack of any other law, there is still something inherently wrong with allowing the rape and death of a seven-year-old. So, even though his complacency led to an atrocious act, his crime can not be tried in any court on earth. On the floor of Congress is a bill which would require all states to passShow MoreRelatedEthical scrap book II final paper 1 1529 Words   |  7 Pagesabout a few things. The topics included good Samaritans, vigilantism, and civil disobedience. We will first address good Samaritans. Good Samaritans do things for other people out of the kindness of their hearts. They don’t do it out of obligation or out of guilt but rather because they feel the desire to help another person. The world would be much better off if it were full of good Samaritans. Some people argue the case of enforcing a Good Samaritan law. This would make it a requirement to helpRead MoreDon Marquis V.S. Judith Jarvis Thomson. 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As I was reading Thomson’s, â€Å"Defense on Abortion† I found myself unsure and often questioning the side she was on. Thomson compiles numerous sides to abortion, giving readers the chance to understand and perceive allRead MorePutting Beliefs About Racism into Action Essay707 Words   |  3 Pageswas bringing a new world order through them i.e. the Aryan race; blonde hair, blue eyes, fair skin: the perfect race. And therefore werent accepting all racial and ethnic groups. But there were some people who were opposed to these ideas, one of these people was Dietrich Bonhoeffer. He preached pacifism (doesnt believe in going to war) and non-violent protests against Hitler. He provided false papers like passports so that Jews could escape. He also revised his pacifist Read MoreOpiates And Its Effects On The Treatment Of Drugs Essay2105 Words   |  9 Pagesaccidental. 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The word parable derives from the Greek word paroblesRead MoreThe Gospel Of Life By Jp II935 Words   |  4 Pagesof fact, the right to life is the foundation by which all other rights are built on. As Christians, in regard to a culture of life, we have to in the words of JP II, â€Å"choose to be unconditionally pro-life† (27). That is, in modern society, there is never a reason to take the life of a human being (aside from self-defense or the defense of others), where life begins at conception and ends at a naturally occurring death. 3. Though the right to life is the initial basis for human dignity, the recognitionRead MoreWhen Bad Things Happen to Good People Essay994 Words   |  4 PagesThings Happen to Good People When someone does something good, great, amazing; however it is said, a reward is expected. That’s just the way the human brain has been trained in many cultures. People think just that with every good deed that is done. Movies have taught us that the â€Å"bad guy† never wins and that a hero will always triumph in the end. Not so much in the real world. Religious views, daily decisions, and just pure coincidence, if you will, all influence the outcome of a good deed. But, whenRead MoreA Defense of Abortion: Most Opposition to Abortion Relies on the Premise That the Fetus Is a Human Being9495 Words   |  38 Pagescontinuous; then it is said that to draw a line, to choose a point in this development and say before this point the thing is not a person, after this point it is a person is to make an arbitrary choice, a choice for which in the nature of things no good reason can be given. It is concluded that the fetus is, or anyway that we had better say it is, a person f rom the moment of conception. But this conclusion does not follow. Similar things might be said about the development of an acorn into an oakRead MoreEssay Religion and Racism1568 Words   |  7 Pagesthree main points, the first is that they were brought up by parents who were racist, and they automatically adopted the views of them because that was all they knew as right. Secondly, when a person came into your land and you had never seen anyone like them before, people could be scared, because people fear what they do not understand. Finally, people who live in an area of poverty often need someone to blame, a famous case of this was in Germany, where food and money