The Pilgrimage by Paulo Coelho Santiago Analysis

The Pilgrimage by Paulo Coelho Santiago Analysis Paulo Coelhos magical novel follows the adventure of Santiago, a young Sheppard from an Andalusian town who disobeyed his fathers will for him to become a priest. For this reason Santiago can be described as a determined, curious as well as adventurous child as he leads his sheep through the unknown deserts. At the beginning of the novel, we see Santiago at an abandoned church, where he has been having reoccurring dreams of a hidden treasure found at the Pyramids of Egypt. Having no knowledge of omens or Personal Legends at that point, he shrugged off this dream until he decided to visit a fortune-teller. Both she and an old man (whom he meets shortly afterward) tell him that he has a quest in life that he must realize, and that is a part of his existence. While pursuing his journey, he learns a fair bit about the world around him. Although he has been grateful to have trusted individuals such as Melchizedek, there were many negative lessons learned such as depression (the Crystal Me rchant), distant love (the bakers daughter) as well as deceit (the thief that stole his money). All of these obstacles held Santiago back on his quest to finding his Personal Legend. However, as the reoccurring quote When you want something, all the universe conspires to help you achieve it (Coelho, 62) remains engraved in his head, his levels of motivation are once again replenished. There are a number of occasions when Santiago is forced to make choices that could alter the outcome of his journey. For example, he had to give up being a Sheppard and sell his sheep in order to have enough money to be able to finance his voyage to Egypt, in hopes of finding his treasure. I find Santiago to be a dynamic character as he matures and finds true love near the end of the book. He has come to learn about the different languages of the world, of the soul and unite himself with his environment. The Soul of the World is one of the biggest spiritual advancements that Santiago discovers througho ut his journey for his Personal Legend. This term is almost directly associated with collective worship. All of these worshippers from different religions worship a certain mystery. But in the end, all of the religions point towards the same mystery that is the true Soul of the World. Santiagos dynamic qualities are more apparent near the end of the book, where he almost gives up completely on pursuing his Personal Legend. Like the Crystal Merchant, he starts to show more materialistic qualities and deems that his current possessions are satisfactory for him and that the journey towards a supplementary but greater treasure is not necessary. Evidence of this is found when Santiago tells the Alchemist I have already found my treasure. I have a camel, I have my money from the crystal shop, and I have fifty gold pieces (Coelho, 115). By the end of the novel, Santiago has acquired a lot of experienced, mostly gained by the knowledge of the Alchemist. Santiago learned to relinquish fear by listening to his heart, which guided him in the right direction and ultimately guided him to his treasure, which was found at the sycamore tree in the abandoned church at the beginning of the novel. Santiagos understanding of the Soul of the World is at its highest point during the event where Santiago was forced to turn himself into the wind by a bunch of warriors from the desert. At that point, Coelho uses figurative techniques in order to bring life to the sun, the desert, the wind as well as the heavens. The use of personification attributed to these elements demonstrates how much Santiago has learned and deepened his understanding of the world. Santiagos experience has brought him to understand the universal language of the world and is thus able to communicate with these inanimate elements. If there was one thing I discovered by the end of this novel, it is that the character of Santiago can be symbolic to the way we live our own personal lives. Like each and every one of us, we have character flaws that can often keep us from achieving our goals in life. Although most of us do not rely on omens in order to know if we are on the right track, we often rely on others invaluable sources such as our family members and friends who provide moral support to help achieve our Personal Legend. Obstacles will surely be met (we have seen many throughout Santiagos journey) however thanks to the help of characters such as the Englishman and the Alchemist, Santiago was finally be able to fulfill his destiny and finally reunite himself with Fatima, the girl of his dreams. ISU Journals: Personal Legend In Paulo Coelhos The Alchemist the author puts a lot of emphasis on Personal Legends. Upon Santiagos quest, he meets a stranger who later reveals himself as Melchizedek, the king of Salem. He reveals to Santiago an important moral rule, in which consists the foundation of Coelhos whole novel: Following ones own Personal Legend. The king describes this legend as A point in someones life where everything is clear, everything is possible. They are not afraid to dream and to yearn for everything they would like to see happen to them in their lives (Coelho, 21). Furthermore, the king explains how there will be difficult obstacles to overcome in the path to realising the personal Legend. One of the obstacles presented in Part 1 of the book is a young boy who agreed to help lead him towards the Egyptian Pyramids for a cost. Little did the innocent boy know that the boy was in fact a thief and that dishonesty runs rampant in the city of Tangier. A second instance is when Santiago meets an Ar abic Crystal merchant, a man who has maintained his shop for over thirty years at the top of a hilly street. Through the crystal merchants character in Part One of the novel, we can see that he was unable to fulfill his own Personal Legend (which was to travel to the Mecca). While reading this particular instance of the novel, I felt that the merchants character greatly contrasts the protagonists quest into pursuing his own destiny. Phrases such as he had been in the same place for thirty years there was a time and it was too late to do anything else really show how much faith the merchant lost in his personal dreams. I found that this really affected Santiagos morality and hence, I listed this figure as an obstacle to the fulfillment of Santiagos Personal Legend. Nonetheless the boys depression was soon relieved once the old merchant offered to help the young boy to fulfill what he once dreamed of doing. ISU Journals: Sheep At the beginning of Paulo Coelhos The Alchemist we are brought upon the idea of the symbolism of the young Santiagos flock of sheep. Santiagos flock of sheep are first presented at the beginning of the novel. The Sheppard and his flock had ventured through the countryside of Andalusia for the past two years in search of food and water. Both the animals and their master have certainly formed a solid bond of friendship and it is explicitly shown in the text when Santiago explains They are so used to me that they know my schedule (Coelho, 4). He would read to them regularly, commentate on the views that they passed by while pursuing their journey and comfort them when they would begin to stir. Santiago also comments that the amount of knowledge and understanding that he received from his sheep is quite superior to that of a book. Although Santiagos gratitude and expressed love for his sheep are inevitable, the greater symbolism lies in the feelings of disgust that he has towards them. While reading the novel, I have noticed instances where Santiago says that the only things that sheep care about are food and water. The simplicity of happiness for animals is greatly contrasted with that of humans. Santiago is amazed by how careless the sheep are of their surroundings so long as they are provided with nourishment. This brought me to recognize that the limited perspectives on life of these sheep could in fact be paralleled with that of the Crystal Merchant as well as the baker. Evidence of this is shown when Santiago says If I became a monster today and decided to kill them, one by one, they would become aware only after most of the flock had been slaughtered.(Coelho, 7) Similarly to the Crystal Merchant and the baker, the sheep care nothing else but their material desires (being the food and water). In the case of the Crystal Merchant, he is too preoccupied with his boring daily life (for more than thirty years) and the desire that everything remains the same. According to the king of Salem, individuals who present similar characteristics to the merchant are unable to fully neither understand nor appreciate their purpose in life, nor the creations of God. This is one of the reasons that have kept them from pursuing their destiny. Setting/ Epoch Paulo Coelhos The Alchemist has numerous settings which progress along with the novel. For instance, the beginning of the story is taken place in the lands of Spain. Evidence of this is shown primarily by the name of the protagonist: Santiago and by the fact that the boy first sets off his journey in the region of Andalusia. Also, there is a passage in the story making relevance to the Moorish invasion over Spain The girl was typical of the region of Andalusia, with flowing black hair, and eyes that vaguely recalled the Moorish conquerors. (Coelho, 5) By this quote alone, we can already assume that the storys epoch is set in a pre-modern context (several centuries ago) during the time in which most technologies such as computers, cellphones were absent. Also, caravans as means of transportation are not used as much in the modern era as opposed to in the story. Additionally, the following quote provides proof of the setting by revealing the type of currency The next day, he gave his s on a pouch that held three ancient Spanish gold coins (Coelho, 9). In addition to the epoch, Alchemy was a practice that had been abandoned years ago as it had been confirmed that you could not turn any stone into another by simply melting it and waiting several years. The setting shifts to another Spanish town located in Andalusia called Tarifa. It is at this landmark that Santiago meets with the king of Salem and is given instructions on pursuing his Personal Legend. Evidence of this is shown when the author describes the scenery and mentions that At the highest point in Tarifa, there is an old fort. Built by the Moors. (Coelho, 33)The plot line shifts continents and is currently found in a city called Tangier, which is found in Morocco (North Africa). We can confirm this setting because we find that the main language is Arabic, which Santiago isnt accustomed to. Clues such as the gigantic pipe (Coelho, 34) which can also be referred to as a shisha; women with their faces covered (34) and priests that climbed to the tops of towers and chanted (34) all suggest an Arabic (Muslim) community. The final setting is in the Sahara desert, in which Santiago crosses in order to get to Egypt. Once again, clues such as the Al Fayoum oasis which is located near the Nile River as well as the Arabic people confirm the final major setting of the novel. Plot summary Paulo Coelhos The Alchemist follows the story of a young Andalusian boy named Santiago whose adventure begins after having a reoccurring dream about him and a mysterious treasure found in the Pyramids of Egypt. Piqued by curiosity, the young encounters numerous individuals, who influence his journey (both positively and negatively) to his treasure. Some of these individuals include: the Gypsy, the king of Salem, the thief at Tangier port, the Crystal Merchant, the baker, the Englishman, Fatima as well as the Alchemist himself. The main event in the story is set when Santiago is forced to make a series of sacrifices in order to obtain his Personal Legend. For example, the first instance is when he follows the king of Salems advice to sell his sheep and to travel to Tangier. The King teaches Santiago about omens which aid Santiago in making the right decisions. However, the young boy got robbed and therefore got a job at a Crystal merchants shop. There, he was able to teach the merchant on the meanings of life and how he shouldnt have given up on pursuing his own Personal Legend to one day travel to the Mecca. By making enough money, Santiago is able to pay his way across the Sahara desert towards the sands of Egypt by means of a caravan. He then encounters an Englishman, who has also set himself on a journey in order to find his Personal Legend (to become an Alchemist). Through this man, Santiago learns about alchemy and the amount of difficulty associated with it. Arriving at an oasis, Santiago envisions a horde of men attacking the desert and warns the chieftains. They were successfully able to defend against these men and Santiago finds the opportunity to meet the Alchemist in person. The Alchemist teaches the boy an innumerable amount of valuable lessons such as listening to ones heart, never giving up, understanding the Soul of the World etc. Santiago is put to the ultimate test when he has been captured by a group of Arabic soldiers and ordered him to turn himself into the wind as a display of his magical powers. By linking his heart to the Soul of the World, Santiago communicates with the sun, the wind and The Hand that Wrote All which invoked a powerful storm that brought Santiago to the other side of the hostile camp. Santiago and the Alchemist were free and Santiago finally makes it to the Pyramids of Egypt. However, Santiago is severely beaten and robbed at his final destination. One of the men describes his own dream as having seen a treasure buried at an abandoned church beside a Sycamore tree in Spain. Alarmed, Santiago finally understood this meaning and found his own treasure which has been at the starting point of his whole journey. Author relevance/ Writing Style Paulo Coelho is the author of one of the most compelling books that I and many others have ever read. I believe that the character of Santiago is easily portrayed by the author himself as both undergo a quest of self-freedom and to find their own happiness. Similar to Santiagos job as a Sheppard, Paulos dream of becoming a writer was heavily frowned upon by the members of his family. His mother told him that his father was a very bright engineer and that becoming a writer wasnt a job that got a lot of praise. As a matter of fact, Santiagos parents were equally perplexed about his dream of becoming a Sheppard. Unlike Coelhos family however, the young boys parents accepted his dream quicker than the author. The turning of point of Paulos life was when he walked the 500 plus mile Road of Santiago de Compostela in northwest Spain. During this pilgrimage, Paulo had a spiritual awakening and therefore had a different view on life. This part of his life had a great impact on his award winning novel. It is without a doubt that the protagonists name had been inspired by the city of Santiago de Compostela. Similar to the sheep in the novel, Coelho lived his life solely on food and water and wasnt living his life in order to pursue his Personal Legend, which was to become a full-time writer. The obstacles that Coelho have faced in order to become a writer, and therefore fulfilling his own Personal Legend, are paralleled to Santiagos own obstacles in the novel. Depression, thievery as well as physical assault are things that both the author and Santiago have undergone before realising their dream. Unlike Coelho however, Santiago had moral guidance as well as charms (Urim and Thummim) in order to guide him to realise his quest with better ease. After having read the authors biography, I find that Santiagos journey was not necessarily an adventure to find a material treasure, but also a pilgrimage for a spiritual awakening (similar to Coelhos path). Important messages such as listening to ones heart, following ones dream, understanding the Soul of the World etc. are things that Coelho himself has also endured. During his pilgrimage, he has ultimately formed a bond with nature and it is very apparent in his writing style when he brings inanimate elements such as the sun and wind to life. Coelho has a very interesting style of writing that appeals a lot to me personally. Many books nowadays are several hundreds of pages long and focusing too much on scenery/setting that often detract readers from understanding any type of moral or life-changing message. Similar to my literary compositions, I strive to only include key points and keep most text-fillers out. Although The Alchemist is a very short novel, Coelho avoids many unnece ssary descriptions such as the scenery, characters and his use of imagery is very limited. Even having completed the novel, we do not know of many of the characters age nor their physical appearance. The reason being is that Coelho neglected most of these useless elements to develop the storys main message: to follow ones Personal Legend. Using a linear progression of writing, the author keeps the story rolling with plot-relevant details such as what the character is doing. Themes/Connections I believe one of the most important messages in this whole novel is to simply follow ones dream. Although this cheesy theme has been recycled many times and can be found in various films and literary works alike, Coelhos writing style is what sets his book apart from the others. For example, the authors use of Alchemy greatly enforces the books central theme. As the practice of Alchemy is to transform an ordinary stone (particularly lead, in this book) to gold, we can metaphorically associate Santiago to a block of lead. The process of alchemy does take several years and this is also associated with the time that Santiago spent in the Spanish pastures, Tarifa, Tangier and the desert in order to better understand his Personal Legend. Once Santiago met the Alchemist (the final piece to the puzzle) he got a crash course on spiritual awakening, listening to his heart/soul and communicating with nature. That was the final process in which Santiago needed to undergo in order for him to be fully transformed from a piece of lead to gold, hence fulfilling his Personal Legend and finding his treasure under the sycamore tree at the abandoned church. Im sure that most of us can relate to this particular theme as we all have had our personal aspirations or goals during our lifetime. When looking at most successful people in the world such as Barack Obama, Donald Trump, Bill Gates or even Steve Jobbs, they didnt lives solely off food and water as the Crystal Merchant, Baker and Santiagos sheep did. They did have material possessions at the time but the difference is that they made risks in their lives in order to achieve their dreams (whatever they may be). The same applies to Santiago, when he made a huge sacrifice of giving up his sheep to get money in order to travel to Egypt. Many novels illustrate some form of sacrifice in order to fulfill their own dreams. Using the books theory, Mother Theresa was also an ordinary woman, who was ordained a Saint several years ago after devoting herself to help the poor. Although I have not figured out my Personal Legend yet, I believe that the book points out important problems with the world around us. I see the Crystal Merchant as a metaphor to the Average Joe of the modern era. A person that is solely content with his material possessions and the ways things are. Even Newtons first law of physics (inertia) shows us that our body loves to be found at a same position and attempts to resist to changes. Consequently, a lot of us dont travel far enough from our comfort zone because we are either scared of the unknown or scared that we will falter. Literary Devices/Predictions In Coelhos novel, the most prominent and important literary device is foreshadowing. My predictions set for my novel are heavily based on the clues I encounter from the reoccurring elements of foreshadowing. However, other literary devices such as irony, metaphors, personifications, symbols, motifs, themes are also included in the novel. The first prediction that I made within the first couple of pages of the novel was his dream about having sought out his Personal Legend in the Pyramids of Egypt along with the help of a boy. Before having completed the book, I assumed that this boy was to be later revealed as an alchemist; however the identity of this boy remains concealed. This element of foreshadowing plays a big role in the overall progression of the book as it is this incident that sparks the whole story line as it initiates him to talk to the Gypsy, in which he later encounters the king of Salem etc. After all of Santiagos influences, Ive came to the conclusion that he would nonetheless have a change in his personality one way or another. Since Santiagos journey relies heavily on the use of omens, it is easy to predict future events and the decisions that he will make in order to accomplish a task. For example, Ive predicted that the Crystal Merchant would surely travel to the Mecca to realise his Personal Legend after having encountered Santiago and deemed him as a good omen. Ive also predicted Santiagos loss of hope and that he would ultimately give up his journey after he packed up his bags to return to Spain. However, I later discovered that the omens of Urim and Thummim have signalled to Santiago that he must not give up and must in fact continue his journey to find his Personal Legend. Further on in the story, I noticed that Santiago and the Alchemist have encountered hostile Arabic soldiers on their way to the Pyramids. I then noted that travelling in such an area would le ad to their eventual capture. On the note of literary devices, personification played a grand role in the development of the climax (human traits were given to the sun, wind as well as the Hand that Wrote All). The story alludes to many characters throughout history as well as mythology. For example, Biblical allusion is made towards the king of Jerusalem Melchizedek who brought bread and wine and offered a blessing (Urim and Thummim in The Alchemist) to Abraham after he won a harsh battle. Also, in the novels prologue, there is allusion to the Greek mythologys Narcissus. This character brings to our attention that everyone is a part of the Soul of the World. Evidence of this is shown when the lake mentions I weep for Narcissus, but I never noticed that Narcissus was beautiful. I weep because, each time he knelt beside my banks, I could see, in the depths of his eyes, my own beauty reflected (Coelho, X).

Estimation of Mound Height in Endoscopic Treatment of VUR

Estimation of Mound Height in Endoscopic Treatment of VUR A Numerical Study to Precise the Estimation of the Good Mound Height in Endoscopic Treatment of VUR Author(s):  Mehdi Shirazi1, Zahra Jahanabadi2, Zeinab Hooshyar5, Zahra Mortazavinia4, Alireza Mehdizadeh3, Mojtaba Taherisadr6 Abstract Purpose: it seems that there is no definite and standard index to ascertain the technique and volume of injection in order to increase the success rate of endoscopic VUR treatment. In this study, we introduced a novel method to numerically define the relationship between some indexes in order to determine optimum mound height promise to standardize the injection technique in this kind of treatment. Material and method: The main purpose of this study is to construct a finite element simulation of intramural ureter and injected mound which aims to numerically define the relationship between indexes which have influence in VUR endoscopic treatment. Using linearization software and numerically simulation data the relationship between effective indexes has been derived. Result: By linearization of the effective parameters of different finite element models, the relationship between effective parameters in filling phase is derived as: H=0.7456D+ 0.02174L +0.01846. This equation depicts adequate injected mound height as a function of internal diameter and intramural length, H=f(L,D). Conclusion: Using numerical simulation, we introduced the novel formula to predict the height of injected mound in endoscopic VUR treatment. As a result of this study, in order to increasing the success rate of this treatment, the ratio of mound height to intramural ureter diameter should be approximately 74% (~3/4). Keywords: Mound height, Endoscopic treatment, Vesico ureteral reflux, Finite element model Introduction Vesico ureteral reflux (VUR) is a major disorder of childhood declared by retrograde urine flow from the bladder toward the kidney, predisposing patients to UTI and renal scarring and in long term leading to renal insufficiency and hypertension[1]. Current treatment options include close observation with urinary chemoprophylaxis, minimally invasive endoscopic subureteral injection of bulking agents and open or laparoscopic reimplantation[2]. The prophylactic antibiotic approach is proper for uncomplicated reflux (grade I-III without significant renal scarring or breakthrough infection)[3]. This type of treatment doesn’t cure VUR and has some problems such as patient noncompliance and increased antibiotic resistance[4]. Surgical reimplantation of the ureter is an invasive method[5] and already used for patients with high grade reflux, children with breakthrough UTI and children with reflux and developed renal scarring[6]. Endoscopic subureteral injection of bulking agents was introduced by Matouscheck as an evolution in treatment of reflux with a high success rate and minimal invasion[6], [7]. The substance used as a bulking material should be biocompatible, nonantigenic, nonmigratory and non-toxic with minimal local inflammation[8]. Multiple techniques on injection have been described. These methods include subureteral needle placement[8], intraureteral needle placement[9], [10] or some combinations of these. During recent years, several studies have been done to determine success or failure of endoscopic treatment, and various injection techniques have been introduced. Puri et al., described â€Å"volcano† appearance as the main sign of success of injection[11]. The proper shape was demonst rated by adequate coaptation of the ureteral orifice and by its location in the bladder below the ureteral orifice and/or along the waldeyer’s sheat[12], [13]. Despite all the studies carried out to determine the success or failure of endoscopic treatment, such as description of volcano appearance, injection technique in combination with hydrodistention, increasing injected volume, use of intraoperative cystogram with a simulated voiding phase, there is no definite and standard index to ascertain the technique and volume of injection in order to increase the success rate. In this study, we introduced a novel method to numerically define the relationship between some indexes in order to determine optimum mound height promise to standardize the injection technique. Materials Method In this study, a computational simulation was proposed to simulate the intramural ureter and injected mound which aims to numerically define the relationship between indexes which have influence in retrograde urine flow from intramural ureter. Geometry of the numerical model Fig. 1 illustrates diagrammatic representation of the functional anatomy of the ureterovesical junction and urinary anti reflux mechanism as the accumulation of urine within the bladder will lead to the tight closure of the portion of the ureter in between, thus preventing the backward return of urine to the kidneys, urinary anti reflux mechanism. In Fig. 1, P, D, H and L are intravesical pressure, intramural ureter diameter, injected mound height, and intramural ureter length, respectively. Section â€Å"A† in Figure 1 depicts the cross section of the intramural ureter with injected mound. The geometrical data of intramural ureter and ureterovesical junction were utilized as per Table 1. Materials Properties and Boundary Conditions Material properties for the intramural ureter wall were assumed to be linear elastic, isotropic, incompressible, and homogeneous with Young’s modulus of 10 Kpa [18]. The injected mound was modeled as a rigid volume as shown in Fig. 3. The boundary conditions for the wall were (1) the bottom surface of intramural wall was fixed at the connection to the internal bladder wall. (2) The upper wall was assumed to be free such that the deformation would occur due to the intravesical pressure and contribute to the tight closure of the portion of the ureter in between. Solution Method The ANSYS 11 software was employed to simulate the intramural ureter with injected mound in voiding phase. The intravesical pressure was applied on the upper portion of the intramural wall. The upper bound of intravesical pressure was considered to be 160 CmH2 O to encompass both male and female intravesical voiding pressures[15], see Table 1. The 8-Node structural solid mesh has been utilized in finite element model to have adequate adoption with this geometry and material behavior. 3 Results Fig. 2 illustrates the total deformation of the intramural ureter with injected mound in voiding phase. As shown, the intramural ureter has been closed due to the intravesical pressure. Fig. 3 shows the deformed and undeformed intramural wall in resting and voiding phase. As shown, in voiding position the injected mound height is high enough for the intramural ureter to be closed due to the intravesical pressure and prevents retrograde urine flow. In the first attempt, keeping the intramural ureter length constant, by changing intravesical pressure and internal diameter, the adequate injected mound height leading to tight closure of intramural ureter was obtained. By linearization of the effective parameters of about 30 different finite element models, the primary relationship between injected mound height, intravesical pressure and internal diameter of intramural ureter was defined as bellow, H=f(D,P) H=-0.0000003219P+0.7864D+0.000233(4) According to this relationship, it has been inferred that intravesical pressure coefficient is minute in comparison with coefficient of other effective parameters and it shows that changing the intravesical pressure plays an insignificant role in adequate injected mound height. In order to investigate the more effective indexes on injected mound height, the intramural length has been considered as one of variable parameters in finite element modeling. Varying internal diameter, intramural length and linearization of obtained data, the relationship between parameters was derived as: H=0.7456D+ 0.02174L +0.01846(5) This equation depicts optimum mound height as a function of internal diameter and intramural length, H=f(L,D). 4Discussion Endoscopic treatment of VUR was introduced more than 25 years ago and since then many different substances and injection techniques have been used with different results[13]. Choosing endoscopic treatment is reasonable, as it has many advantages, such as technical simplicity, greater acceptance of patients and parents and significant decrease in post- operation complications[7]. By improving the injection techniques the rate of endoscopic treatment has significantly increased as compared with open ureteral reimplantation[2]. During the recent years, many studies have been done to increase the ability to identify factors predicting success with the endoscopic subureteral injection[19]. At 2003, Puri et al.[11] described â€Å"volcano† appearance as the main sign of success of injection. The proper shape was demonstrated by adequate coaptation of the ureteral orifice and by its location in the bladder below the ureteral orifice and/or along the waldeyer’s sheat[12]. In different studies conducted by Lavelle et al.[12] and Yucel et al. [20], it was found that a subjectively proper mound appearance was highly predictive of injection success, but it should be noted that the morphology and location of the mound are not perfectly predictive of injection success or failure, as the mound seems perfectly adequate in some injections but the injection is not successful; also, the imperfect mound morphology does not necessarily imply injection failure[12]. Moreover, Ellworth PI et al. showed no correlation between the presence of a mound on post-injection ultrasound and the success of injection[19]. Some research agrees that an intraureteral injection technique in combination with hydrodistention results in higher success rates but this is controversial[9],[10],[20],[21]. The effect of injected volume on increasing the success rate is also controversial. Mathew D et al. showed that increasing the injection material volume will improve the success of subure teric injection[22] but other centers have shown that higher injection material volume doesn’t necessarily increase the treatment success rate[21]. So the effect of the injected volume in association with improved success rate remain unclear[12]. To determine the treatment success or failure, Tarry WF et al. described the utility of an intraoperative cystogram with a simulated voiding phase, but they demonstrated that an introperative cystogram can only detect de novo contralateral reflux but is not a proper method to predict the final success of injection[6]. Despite all the mentioned studies, still there is no definite and standard index to ascertain the technique and volume of injection, and also there is no quantitative index for determining the proper mound size and shape. So, we have conducted a study aiming to define an optimum injection mound by finite element modeling. In this study, we introduced a novel method to numerically define the relationship between some indexes in order to determine optimum mound height promise to standardize the injection technique in VUR treatment. It should be noted that due to every patient individual properties of intramural, it is not logical to consider similar injected mound height for all VUR treatment cases. Thus, it is needed to state the adequate injected mound height based on individual indexes of each case. The Intravesical pressure, intramural ureter diameter and length are some of these effective indexes. By specifying the relationship between all of these effective factors, the adequate and optimum injected mound height can be determined which can contribute to more success in treatment of VUR. In addition, it can help to save the needed injected mound height and make this injection method more economical. The results of this study show that the intravesical pressure has an insignificant effect on the required injected mound height. However, intramural length plays an important role on it in comparison with Intravesical Pressure. Moreover, the ratio of mound height to intramural ureter diameter is approximately 0.74 (~3/4), which is drawn that in order to have successful VUR treatment, it is needed that about 74% of intramural ureter diameter be filled with the injected mound. It should be mentioned that in Department of Urology of Shiraz University for the first time, an innovative method, introduced by Taheri et al.[23], is used to measure the injected mound height to assure the adequate injected mound height. In this method by adjusting camera, laparoscopy lens and imaging screen, it would be possible to measure the injected mound height as a ratio of projected picture on the screen. This study has served some limitation. The realistic cross section of intramural ureter has star shape. However, because of some limitation in finite element modeling, the circular one considered. Furthermore, we considered computational simulation only in voiding phase, although VUR may occur in resting phase. Conclusion In this study using numerical simulation, we introduced the novel formula to predict the height of injected mound in endoscopic VUR treatment. As a result of this study, in order to increase the success rate of this tevhnique, the ratio of mound height to intramural ureter diameter should be approximately 74% (~3/4). Moreover, clinical study has been conducted to ascertain the accuracy of this obtained height. Fig. 1Diagrammatic representation of the functional anatomy of the ureterovesical junction Fig. 2Intramural ureter displacement in voiding phase Fig. 3Deformed and undeformed intramural urine wall References Lenaghan, D., et al., The natural history of reflux and longterm effects of reflux on the kidney. J Urol, 1976. 115(6): p. 728-30. Cerwinka, W.H., et al., Radiologic features of implants after endoscopic treatment of vesicoureteral reflux in children. AJR Am J Roentgenol, 2010. 195(1): p. 234-40. Harper, L., et al., Postoperative cystography and endoscopic treatment of lowgrade vesicoureteral reflux. J Laparoendosc Adv Surg Tech A, 2008. 18(3): p. 461-463. Hsieh, M.H., et al., Treatment of Pediatric Vesicoureteral Reflux Using Endoscopic Injection of Hyaluronic Acid/Dextranomer Gel: Intermediate-term Experience by a Single Surgeon.j urology, 2010. 76(1): p. 199-203. Elder, J.S., et al., Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children. j urology, 1997. 157(5): p. 1846-1851. Perlmutter, A.E., et al., Utility of an intraoperative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux. W V Med J, 2008. 104(4): p. 22-4. Rivilla, F., Endoscopic treatment of vesicoureteral reflux in a paediatric surgery ambulatory unit. Vol. 7. 2011. 132-5. Bae, Y.D., et al., Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique ®) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux ®). Korean J Urol, 2010. 51(2): p. 128-131. Gupta, A. and W. Snodgrass, Intra-Orifice Versus Hydrodistention Implantation Technique in Dextranomer/Hyaluronic Acid Injection for Vesicoureteral Reflux. J urology, 2008. 180(4): p. 1589-1593. Kirsch, A.J., et al., The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J urology, 2004. 171(6 Pt 1): p. 2413-2416. Puri, P., et al., Treatment of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid Copolymer: Preliminary Results. J urology, 2003. 170(4): p. 1541-1544. Routh, J.C. and Y. Reinberg, Predicting Success in the Endoscopic Management of Pediatric Vesicoureteral Reflux. Uro, 2010. 76(1): p. 195-198. Lavelle, M.T., M.J. Conlin, and S.J. Skoog, Subureteral injection of Deflux for correction of reflux: Analysis of factors predicting success. Uro, 2005. 65(3): p. 564-567. Yeung CK, G.M., Duffy PG, Ransley PG., Nat<

Wal-Mart Essay -- Chain Stores Wal-Mart Sam Walton Essays

Wal-Mart Wal-Mart started out as a five and dime store by Sam Walton back in the 1950’s in Rogers, Arkansas. From those humble beginnings, Wal-Mart is now the world’s largest corporation passing the likes of U.S. Steel & GM with over $256 Billion in sales for one year announced at an annual stockholders meeting. What makes Wal-Mart so successful? The rise of technology and the explosion of the global economy, coupled with the effort of keeping prices as low as possible has propelled the conglomerate into becoming the world leader in logistics. They were one of the first to understand the power of the barcode. They also shifted the industry from ‘Push’ to ‘Pull’ production, meaning retailers would decide what and how much a manufacturer should produce. Due to the power possessed by Wal-Mart, other companies and suppliers have set up satellite offices around their corporate headquarters in Bentonville, Arkansas. Rubbermaid, stationed in Wooster, Ohio, wasn’t well known until their variety of products donned the shelves of Wal-Mart. In 1994, they were voted as the most admired company in America for its quality due largely to its partnership with Wal-Mart. Raw materials among other materials of production increased for Rubbermaid which meant a price increase to all of its retailers. Wal-Mart wouldn’t accept the price increase and subsequently dropped a number of Rubbermaid products, which began the decline for the company. Newell, a rival, bought out Rubbermaid for...

College Essay examples -- Teaching Education

College Every person who begins a college career has a multitude of reasons for doing so. Some people do it because they are expected to get a college degree. Others do it hoping for a better life than they could have without a college degree. I am not entering college for either of these reasons. I am a high school dropout who believes I can do better than I did. Therefore, my reasons for beginning college are some what different than the average person starting college for the first time. I have something to prove to myself. I want to prove that I can earn a college degree. I am beginning college after a long hiatus from the academic world. You see I dropped out of high school in 1973 after completing my sophomore year. I was young and in love with the man to whom I am still married. School was never a problem for me, however; I was eager to begin my adult life and high school was not part of my plan. I wanted children right away. Subsequently I gave birth to my first child, Tosha, in 1974 and education became the furthest thing from my mind. After all, I had a baby to care for and love. Twenty-two months later I had a son, Jason. I was a stay at home mom with two children. I didn’t begin work until both of them were school-aged. I held various jobs until 1985 when I became employed at Andover Togs in Pisgah. I still had not completed my high school education at this point. My children had always me to get my GED. I had excuse after excuse for no...

Breakfast of Champions Essay -- essays research papers

Breakfast of Champions   Ã‚  Ã‚  Ã‚  Ã‚  Have you ever read a book and enjoyed it, but once you were finished you wondered what it was really about? You wondered if the book had a deep meaning that you had to sit and think about or if the book was just for entertainment purposes only and had no meaning whatsoever. For me, Breakfast of Champions by Kurt Vonnegut Jr. was this type of book.   Ã‚  Ã‚  Ã‚  Ã‚  Breakfast of Champions is a story about two men who are going to eventually meet each other at a festival for the arts. The story tells about their journey in detail and explains how each man perceives and reacts to society.   Ã‚  Ã‚  Ã‚  Ã‚  Dwayne Hoover, a Pontiac salesman, is on the brink of insanity. Dwayne is a very â€Å"well-to-do† man and owns many businesses in Midland City where he resides. In the blink of an eye Dwayne’s life changes forever. One day Dwayne’s wife drinks Drano and is killed. After this incident Dwayne’s body starts producing â€Å"bad chemicals† which causes him to become insane.   Ã‚  Ã‚  Ã‚  Ã‚  The other main character of this book is a man by the name of Kilgore Trout. Kilgore is an interesting character. â€Å"Trout,† as he is referred to in the book, is a lonely person who thinks everyone in the world is against him. Trout lives by himself and sells screening and siding for houses. Trout’s best and only friend is his bird named Billy. Trout is a struggling writer whose work is mainly published in pornog...

Allegory Criticism

Allegory Criticism: Essay #3 Da’Andrea Bell Allegory criticism is an extended metaphor in which a person, abstract idea or event stands for itself and for something else. Usually involves moral or spiritual concepts which are more significant than the actual narrative. In the fiction reading, â€Å"The man In the Black Suit† by Stephen King, the main character Gary a young boy at the age of nine has found himself coming face to face with someone he believes is the devil. While out for a day of fishing Gary is approached by a man mysterious looking man. In the reading the author describes this mysterious man, â€Å"His face was very long and pale.His black hair was combed tight against his skull and parted with rigorous care on the light side of his narrow head. He was very tall. He was wearing a black three-piece suit, and I knew right away that he was not a human being, because his eyes were the orangey red of flames in a woodstove. I don’t mean just the irises , because he had no irises, and no pupils, and certainly no whites. His eyes were completely orange-an orange that shifted and flickered. And it’s really too late not to say exactly what I mean, isn’t it? He was on fire inside, and his eyes were like the little isinglass portholes you sometime see in stove doors. Something that he has never witnessed just has always heard about in church and from what his parents always taught him when growing up. His innocent is threatened. Stephen King uses everyday events and objects to represent spiritual references, including the characters. The man in the black suit represents the devil and the young boy represents purity and innocents. The setting also sets the mood, where King sets majority of the reading in the woods, a place what is usually looked at as a place that kids are not allowed to go by themselves.The woods were usually looked at as the forbidden part of the yard. As Gary goes further in the woods is when Gary comes in contact with the man in the black suit which is referred to as the devil himself and also the bee; which Gary believes it is the same exact bee that killed his brother. Gary is forced with facing impure spiritual desires; such as the fear of possible death, embarrassment (when he peed on himself), shame and also the possibility of being deprived of the ones closets to him. When finally able o get himself together, Gary snaps into action and is able to run for his life and shake the devil off. Gary does not believe that he was dreaming, but that the evil he has encountered is reality and that they actually took place. Also when the father goes looking for Gary, the look on his face and actions shows that he too has also encountered it once before. Gary is just lucky that he has been able to live to tell the tale. Work Cited â€Å"The Man in the Black Suit. †Ã‚  Analysis. N. p. , n. d. Web. 03 Nov. 2012. . Mulverhill, Gisele. â€Å"Short Story Reviews: The Man in the Black Suit, by Steven King. â€Å"Helium. Helium, 19 Aug. 2010. Web. 03 Nov. 2012.

“Bring Back Flogging” Response Paper Essay

In Jeff Jacoby’s essay, â€Å"Bring Back Flogging,† he strongly reveals his opinions and beliefs on corporal punishment. Jacoby illustrates the use of verbal irony and sarcasm. He applies verbal irony and sarcasm in such a way that by reading what is written is easily understood to interpret what he really means. Jacoby describes what flogging is, how it was helpful, and argues that flogging needs to be brought back to our society. After reading Jacoby’s argument for bringing back the harsh beating and whipping, called flogging, I see that flogging would be helpful if it is brought back. Flogging is exercising the practice of brutal beatings and whippings. Flogging has been practiced by the Puritans in 1632, all the way to 1972 when it was repealed. The Puritans acted in flogging when offenders were sentenced for committing a crime, such as adultery or blaspheme. When convicted of the crime an individual committed, they were tied to a post in public, with no shirt, and severely flogged. By practicing flogging, and displaying the beating to the citizens of the town, the citizens could see what would be done for their punishment if they commit the same or different crime. If flogging were to be brought back and routinely practiced on offenders of certain crimes, and the beating was displayed to the public, it could greatly reduce crimes committed. Being whipped is not any more or less degrading that being locked in a cage, like an animal. Bringing back flogging would inspire possible criminals not to commit a crime that they could be planning. By being whipped in public, the offender will be highly embarrassed and have severe pain. Hopefully this felling of embarrassment and the pain experienced will stay with them, if they think of committing another crime. Also, after beaten the wounds will turn to scars, these would serve as a permanent reminders of the consequences obtained from their actions. Prisons are packed tightly with hundreds of criminals. Some prisoners are violent offenders and others are not. Providing meals, building new jails,  keeping a prison running, and providing prisoners with necessities, is very expensive. If flogging was the consequence of committing crimes, the money spent in and for prisons, could be used for other and more important items, such as books for school systems. In addition, less dangerous offenders will not be abused or raped in prison. The practice of flogging would also increase prison space for more dangerous offenders. Bringing back the punishment of flogging would greatly reduce crimes committed. Also, the public display, pain, and the permanent reminder from scars, will reduce the possibility of participating in the crime again. It would also serve as a physical image to others of what will happen if they commit a crime. Puritan forefathers had an excellent idea of punishment for committing crimes. Flogging was also a very effective punishment. The knowledge of what will happen if a crime is committed, and knowing how painful it is, will allow individuals to think thoroughly if they ever decide they want to commit a crime. I vote to bring back flogging!