Beam Energies Treatment for Lung and Larynx

Beam Energies Treatment for Lung and Larynx Larynx Error Plan Errors: Beam energies for larynx treatment are not correct both fields have 10MV instead of 6MV Field sizes are not right The Right Lateral (RLat) field is too big resulting in shielding errors The Left Lateral (LLat) field is too small and is just skimming the anterior portion of the patients shell The number of fractions on the plan is one (1) instead of 20 daily fractions. The global maximum dose is 110.98% (given as 6103.7 cGy) and is largely outside the Planning Target Volume (PTV), meaning the plan is too hot The 108% region is a hot spot as it exceeds the International Commission on Radiation Units and Measurements (ICRU 50 62) maximum value of 107% The LLat field wedge is too thin 1o, so not helping with uniform dose distribution of the plan, hence the right skewed isodoses and the 108% hot spot The plans maximum spinal cord dose of 5112 cGy, exceeds the maximum dose constraint value for the organ of 5000 cGy. Multi-Leaf Collimators (MLC) use on the plan There is not much conformality to the PTV anteriorly from the RLat field There is insufficient shielding of the neck anteriorly Some MLC are not pulled up properly as they are on the field edge which is better shielded by the Primary collimators The RLat field is over-wedged (60o), resulting in the 108% hotspot region The RLat field is not placed optimally re-collimator angle in order to better avoid the spinal cord The Dose Volume Histogram (DVH) data/graph/chart is insufficient as it is only for the spinal cord excluding for example the PTV information The isocentre could be placed more centrally for the plan Criteria use to evaluate the suitability of the treatment plan This is a conventional parallel-opposed field arrangement, which is suitable for head and neck treatment of the larynx (Barrett and Dobbs, Practical Radiotherapy Planning, page 171). Since this is an error plan, the fields do not match in size though they are parallel opposing. The radical dose prescription is 55 Gy in 20 daily fractions of 2.75 Gy over 4 weeks (Barrett and Dobbs, 4th Ed., page 175). This would apply as a prescription for a T1-2 N0 glottic larynx tumour with a volume of 26-49 cm3 (RSCH, St Lukes Radiotherapy Clinical Protocol, Head and Neck Larynx). Use is made of isodose charts, PTV coverage as indicated by the D95 (95% isodose line), maximum PTV dose (Dmax), maximum spinal cord dose, dose volume histograms (for PTV and spinal cord), and departmental protocols to evaluate the suitability of the treatment plan. The Quantec/Emami et. al. (2013) document of Tolerance of Normal Tissue to Therapeutic Radiation provided the dose constraints for the organs at risk e.g. the spinal cord. NICE guidelines only stipulate an offer of choice of trans-oral microsurgery or radiotherapy to people with newly diagnosed T1b-2 squamous cell carcinoma of the glottic larynx. The plan is optimised by use of beam modifying devices like wedges and MLC (Barrett and Dobbs, page 171), and checking the effect using the planning software. Solutions to eliminate identified errors: The beam energy needs to change from 10MV to 6MV in the field properties of the planning software. This will ensure adequate coverage of the PTV as a significant part of the larynx is very close to the skin. A less energy beam offers less penetration and lower build up depth (for skin sparing effect) for dose deposition. The RLat field size can decrease slightly anteriorly, while the LLat field size can increase slightly to ensure adequate anterior coverage. The fields could also be more symmetrical. The LLat wedges orientation needs to change so that the Thick end is Anterior as per the setup information (Toe in). The number of fractions is should change to 20 from the current one fraction. This would give the appropriate dose prescription for the plan of 55Gy/20#/4weeks/2.75Gy per fraction The current plan is too hot, so the beam weightings need adjusting downwards until the plan conforms to the ICRU limits of maximum 100% + 7% (= 107%), and the lower limit of 100% 5% (= 95%) of the proscription dose (ICRU). This process can also improve by correcting the wrongly orientated LLat wedge and using a better wedge angle on it, as well as adjusting down the angle of the over-wedged RLat wedge. Correcting the 108% hotspot region is through adjusting the wedge angles, re-orienting the LLat wedge and adjusting the field weightings. The thin 1o LLat wedge angle needs changing up to 30o for the wedge to have an effect on the isodose distribution, on top of reversing its orientation. This would help in creating a uniform dose distribution for the plan and a reduction/elimination in/of hotspots. According to the Quantec/Emami et al. (2013) guidelines, the spinal cord is to receive a maximum core dose of 50Gy, but the current plan is exceeding this limit. Adjusting theÂÂ   collimator angle for the fields to be parallel to the spinal cord will help avoid treating this critical organ This is also aided by reducing the field weightings, adjusting the wedge angles and orientation of one of them, adjusting the field sizes posteriorly. The MLC leaves need to close where they are open outside the treatment field edges. There is a leaf to shield the anterior corner of the neck but is pulled back, so needs to be part of the configuration. There are five (5) pairs of almost central leaves, that are on the field edges inferiorly and superiorly, they need pulling back by 0.5 cm from the field edge so they do not interfere with primary collimation (Royal Surrey County Hospital (RSCH), St Lukes Radiotherapy Clinical Protocols). Adjusting the RLat field size anteriorly will aid in correcting the shielding of the neck and improve conformality to the PTV. The RLat field wedge needs reducing to at most 30o to aid uniform dose distribution and reduction of hotspots. Changing the collimator angle of the RLat field so that it is parallel to the spinal cord, will avoid treating through this critical organ. This will result in reducing the spinal cords maximum dose for the plan to within the organs maximum dose constraint value of less than 50Gy, thus aiding in optimising the plan. The DVH information of the plan should include the PTV data and line plot to enable plan evaluation of its suitability. Making the isocentre more central may improve the uniform dose distribution of the plan. Suitability of Plan and Alternative beam arrangement According to De Virgilio, A., et. al. (2012), there is currently no set therapeutic gold standard for the treatment of laryngeal squamous cell carcinoma. This contributes to a lack of consistency and inhomogeneity in treatment planning. The plan under consideration is a 2D conventional plan, which in itself is suitable with the exception of the errors, but is not optimal. The identified errors are correctable and the plan optimisable. In remaining with the conventional plan, a third anterior low-neck field with a light weighting (3DCRT) is an option to improve dose distribution and eliminate hotspots. However, this would require the addition of electron beams to match the photon fields, according to Herrassi, M. Y., Bentayeb, F, and Malisan M. R. (page 98-105). Another option is to use Intensity Modulated RadioTherapy (IMRT) with 3 or 5 beams, or Volumetric Modulated Arc Therapy (VMAT) with one arc, (Matthiesen C, SinghÂÂ   H, Mascia et. al. (2012)). IMRT offers more conformalit y in regards to carotid arteries as stated by Gomez, D., Cahlon, O., et. al. (2010). Portaluri, M., et. al (2006), suggest that 3D Field-in-Field techniques are a valid alternative as they offer the best global performance when considering PTV coverage and parotid sparing. Conclusion The task was instrumental in reinforcing the importance of understanding the process of treatment planning, and how to check the suitability of the plan before its approval. There is not much information to work with in suggesting alternative beam arrangements. Useful information could have been correct TNM classification, appropriate oncological classification taking into account the anatomic-embryologic and functional complexity of the larynx. There were glaring errors in the plan, and as an exercise, they were useful in sharpening treatment planning knowledge. IMRT is the preferred treatment technique that is efficacious especially for parotid gland and carotid artery sparing. Lung Plan Errors: Beam energies should all be 6MV, some are 10MV on the plan There are too many fields for the plan The LLat beam is going through the contralateral lung The field placement of the right posterior oblique (RPO) is not optimal as its MLCs are shielding part of the PTV contributing to the inadequate 95% dose coverage of the PTV. The global max value of 109% exceeds the ICRU guidelines, meaning the plan is very hot in places. There is an 80% hot spot on the chest, which is very hot for the area close to the skin There are many wedges on this plan resulting in hot and cold spots and a high dose gradient in the PTV. The Right Lateral and Anterior fields are over-wedged, resulting in the 80% and 109% hot spots. The RPO and LLat field wedge angles are not conventional (50o and 33o respectively, when considering the standard wedge angle specifications of 15o, 30o, 45o and 60o. The Lateral fields (Right Lateral and Left Lateral), are too big in relation to the size of the PTV, resulting in unnecessary irradiation of healthy tissue. The current plan exceeds the spinal cord core dose (maximum 50Gy), as interpreted from the DVH data. There is less than 95% PTV coverage laterally , resulting in a max dose to the PTV of 5304 cGy, which is very much less than the expected 6080 cGy (95% of 6400 cGy). Criteria use to evaluate the suitability of the treatment plan Barrett and Dobbs (page 252), acknowledge that there are a number of challenges to covering the PTV fully and remaining within the ICRU constraints, while maintaining acceptable toxicity levels at the same time. A three (3) field conformal plan is normally used for stage I or II non-small cell lung cancer (NSCLC). A compromise on choosing the best plan is mostly dependent upon the location and size of the PTV, and its closeness to critical structures, like the spinal cord and oesophagus. The plan should try to minimise dose to the contralateral lung as much as possible by using anterior oblique, posterior oblique and lateral beams. Beam modifying devices such as wedges compensate for obliquity at the chest, with MLC shielding conforms each beam to the shape of the PTV (Dobbs and Barrett). Use is made of the Quantec/Emami et. al. (2013), document on Tolerance of Normal Tissue to Therapeutic Radiation in checking dose constraints to organs at risk e.g. brachial plexus, oesophagus and spinal cord. Plan evaluation also uses isodose charts, dose volume histograms and departmental protocols to establish the suitability of the plan. NICE guidelines for Radiotherapy with curative intent for Non-small cell Lung Cancer stipulate that the patient should have good performance status (WHO 0 or 1). It says, CHART should be offered first, but if unavailable then conventional radiotherapy of 64-66 Gy in 32-33 fractions over 6 ÂÂ ½ weeks or 55 Gy in 20 fractions over 4 weeks is the next option. This plan is for 64 Gy in 32 fractions over 6 ÂÂ ½ weeks, so meets with this criterion. Dobbs and Barrett (page 253), mention that careful evaluation of the plan using DVHs is especially important when considering keeping the V20 below 32 per cent (the volume of lung receiving more than 20Gy of the dose). Solutions to eliminate identified errors: Barrett and Dobbs (page 255), point out that beam energies above 10 MV should be avoided due to greater range of secondary electrons in lung tissue, which result in a wider penumbra and thus more radiation to normal tissue. Beam energy of 6MV is adequate, while use of 10MV is for separation at the centre is greater than 28 cm. (Dobbs and Barrett, page 252). As no mention of the separation, it is appropriate to use 6MV on all the beams for this plan instead on mixed energies. This is a conventional plan, and the common number of beams 3 instead of the current 5. The many fields have not helped in conforming the plan to the PTV and improving the dose distribution, but have contributed in unnecessary irradiation of normal tissues. So, removal of the anterior and left lateral beams, would bring the plan back to a conformal 3 field plan. The right posterior oblique field would need setting at around 215o-225o in order to cover the PTV better and its MLC not to shield the PTV as at the present. (RSCH and London Cancer centre protocols). The left lateral field is treating through the contralateral lung, which is operationally against ICRP (2007), ICRU and IR(ME)R 2000 guidelines of keeping dose as low as reasonably achievable (ALARA) to patients, employees and the general public. The corrective measure is to remove the left lateral field from the plan. The gantry angle for the right posterior field is not optimal and moving it to around 215o-225o range would improve coverage of the PTV and avoid the spinal cord, even though the MLC is shielding the cord (ideal) in the current setup but also part of the PTV that is not ideal and compromising the 95% coverage of the PTV. The global maximum value of 109% exceeds the ICRU target of maximum 107% within the PTV. Removing the anterior and left lateral fields, and adjusting the over-wedged posterior and right lateral field wedge angles to either 15o or 30o depending on the uniformity of the dose distribution within the PTV, will rectify this issue. The remaining field weights will need adjusting as well to fully optimise the plan. Moving the RPO beam angle to between 215o and 225o, as well as reducing the wedge angle to 30o and removing the anterior beam from the plan will correct the 80% hotspot region. Removing the anterior field will effectively eliminate the 80% hot spot region on the chest. Removing the left lateral field and wedging the right anterior oblique field will help in reducing or eliminating the 109% hot spot region in the PTV. These measures will also result in more uniformity in dose distribution when combined with adjusting the weights of the remaining fields. The current plan has many wedged fields (some over-wedged), which is rectified by removing the anterior and left lateral field from the plan, adjusting the right lateral wedge angle to either 15o or 30o, and that of the posterior field from 50o to either 15o or 30o and inserting a 15o or 30o wedge on the anterior oblique field. This should improve the uniformity of the dose distribution within the PTV. The non-conventional wedge angles of the posterior and left lateral fields (50o and 33o respectively), have not improved the dose distribution in any noticeable way, as there is still a high dose gradient in the PTV. Reverting to the standard angles and using either 15o or 30o at most, would improve the dose distribution of the plan. The two lateral fields are too big; therefore adjusting them posteriorly would improve the PTV coverage of the plan and less irradiation of normal tissue. The left lateral field however needs taking off the plan altogether. The current plan shows excessive dose to the spinal cord and according to the Quantec/Emami et. al. (2013) document, the maximum core dose to the spinal cord should not exceed 50Gy. Moving the right posterior field angle to 215o-225o range and removing the anterior beam will correct this anomaly The less than 95% coverage of the PTV is achieved by: positioning the posterior field optimally (between 215o and 225o), so that the MLC will not shield the PTV but still manage to shield the spinal cord; adjusting the field sizes of the oblique fields; applying 15o or 30o wedge to the right anterior oblique field andÂÂ   adding MLCs to it so that it conforms the PTV better thus improving the dose distribution to the plan; and applying MLCs to the right lateral field to conform the PTV better. Suitability of Plan and Alternative beam arrangement This plan is not suitable for patient treatment in many respects, as highlighted by the errors identified. Improving it is by reverting to the conventional three field/beam plan, with two right oblique fields and the right lateral field as the third one (Barrett and Dobbs, page 252). Other treatment techniques, e.g. IMRT (with emphasis on carotid sparing), helical tomotherapy, VMAT have been found to offer better results on dosimetric comparisons. However, a multi-modality approach could be the best approach when considering new data coming from immunology, molecular biology and genetics on top of the usual surgery, chemotherapy and radiotherapy treatment options (Franco, P., et. al. (2016)). Conclusion This exercise highlighted the importance of quality assurance and having several layers of checking the suitability of treatment plans that are eventually used on the patients.

The European Revolutions of 1848 Essay -- European History

The revolutions of 1848 were widespread and affected about 50 countries in Europe, considering the previously separate lands of Germany and Italy. These revolutions were extremely violent and costly. In terms of lives, tens of thousands were lost during battles with several thousand more being lost in executions. Over 100,000 individuals were jailed or exiled as well. While these individual countries had significant nationalistic grievances, such as anti-Austrian attitudes in Italy, anti-Russian and anti-Turkish opinions in Rumania, anti-Habsburg in Prague and Budapest, German patriotism divided German as did Polish patriotism in Poland; it was the political and economic struggle that were the prevailing catalysts for the revolutionary uprisings. There was widespread economic crisis in the European continent in the mid 19th century. Agricultural failures from 1845-1847 which resulted in increased food prices impeded the people’s ability to buy food. The people in Berlin were so angered over the cost of food that they rioted for four days. A third of the German population was on government relief by 1847, resulting in the number of Germans leaving for the United States in search of farmland to increase dramatically. In Prussian Silesia and Austrian Galicia over a quarter of a million people died as a result of starvation. Anger over the ancient regime of government and its political tyranny was viewed as the single most important cause of the numerous revolutions. Heightened political awareness due to the invention and extensive use of the printing press was instrumental in fostering political awareness of new ideas such as liberalism, nationalism and socialism. Additionally, many of the countries were aware of the succ... ... positive results of the uprisings were the spread of parliamentary governments, the allowance of manhood suffrage in France and briefly, in Austria, the elimination of lord owned and tenant farmed land in Central Europe, the beginnings of the German and Italian unification movements, and the establishment of Hungary as an equal partner with Austria under Hapsburg rule. Works Cited Western Civilization: A Brief History, Complete [Paperback] By Marvin Perry, Publisher: Wadsworth-Cengage Publishing; 7th edition 2010 pp 333-347 â€Å"Sparknotes† http://www.sparknotes.com/ Linked from â€Å"Sparknotes† The Revolutions of 1848 (1848) http://www.sparknotes.com/history/european/1871/section1.html â€Å"Fordham University† http://www.fordham.edu/halsall/mod/modsbook.asp Linked from â€Å"Fordham University† Encyclopedia of 1848 Revolutions http://www.ohio.edu/chastain/index.htm

Google Glass Essay

Google Glass should be prohibited to be public for the world. In consequence of technological advances, we have changed our society and have been convenient for few decades. Thanks to advanced technology, we eventually became possible to do anything we want with electronic devices from modern technology. At this point, Eric Schmidt, who is a current Google’s executive chairman, announced that Google will commercialize Google Glass by the end of 2013. Google Glass is a wearable computer with a head mounted display by Google in the Project Glass, research and development. Google glass displays information in a smartphone-like hands-free format that can interact with the internet via voice commands. Briefly, it’s going to be like a smart phone wearing on our eyes. It is believed that modern technology has brought many benefits to us, we should be aware that it’s possible to use for our society. Firstly, the public would be threatened by Google Glass seriously. Inverters of Google Glass say that Google Glass will be equipped with an intellectual camera that can take clear pictures at anytime, anywhere. It means that taking picture with a Google Glass can lead to an invasion of portrait right. Furthermore, it doesn’t have any speakers to let other people know that users are in the process of recording. For instance, cell phones and camcorders have speakers exceeding a background noise level of 60~70dB. Instead of loud speakers, it has bone-conduction headphones near frames. But it mustn’t be a function as alert sound. Secondly, Google Glass will absolutely affect our body badly. What would happen if we wear Google Glass for very long time? Every electronic device has electromagnetic waves as always. According to Interphone Study Group in France (ISG), 2 billion people will have brain cancer by 2020 from cell phones. Unfortunately, Google Glass has the same critical influence as the cell phones have. If we wear Google Glass, we might as well face a terrible situation like ISG said. Moreover, they are saying that a new psychological disease called â€Å"nomophonia’, which makes us feel nervous because of not holding own our device, will occur at the moment. I’m sure that it would be a disaster for us as well as our next generations. At last, I’d say that there will be liability problems by being obsessed with Google Glass. People will wear Google Glass while driving in spite of definite warnings not to do. After that, they will clash with the elderly or any pedestrians and somebody will get hurt seriously. The medical insurance may not be possible to cover the medical care because money can be critical. If Google Glass is commercialized, we will have to take up a liability insurance to use it. It means the we need to add cost of an insurance policy to Google Glass bill. Of course, Using Google Glass will make our life slightly more comfortable and convenient. On the other hand, we should deeply think it has so many side effects that can badly effect to our society. Therefore, I hold very strongly that organizations in charge of license of selling electronic devices shouldn’t allow to release into the world.

Confused By Your New SAT Score 2 Controversies, Explained

Confused By Your New SAT Score 2 Controversies, Explained SAT / ACT Prep Online Guides and Tips With the launch of the redesigned SAT in March of 2016, a new era was born in standardized testing. While the College Board was hopeful that there would be no issues with the new test or its familiar scoring system (maximum score of 800 per section), unfortunately there have been scoring issues that are confusing and upsetting students. Furthermore, the College Board has managed to irk its arch nemesis, the ACT. In this article, I’ll break down these controversies and explain what they mean for you. The New Scores Are Inflated The biggest issue with the new scores seems to be that scores on the redesigned SAT are slightly higher compared to those from the old SAT. For example, a 1300 on the new SAT corresponds to a 1230 on the Math and Critical Reading sections of the old test. A 730 on the new Math section is equivalent to a 700 on the old one. Here’s a chart comparing the old combined SAT scores to the new ones. New SAT scores were multiplied by 3/2, so all scores could be out of 2400. Basically, this chart reveals what the new SAT scores equate to on the same scale as the old SAT. At almost every point along the curve, the new SAT score is roughly 80 points higher than you would expect from the old SAT. After students got back their scores from the first administration of the new SAT, many were very happy with their scores until they learned that their scores were not as good as they thought. His score wasn't as good as he thought. Why Are the Scores Higher? We believe that the scores on the new test are higher because of the elimination of the penalty for wrong answers. The College Board didn’t compensate for the higher raw scores that inevitably result from no guessing penalty and one fewer answer choice. Other than at the lowest score levels, the same percentage score equates to roughly the same scaled score. If you got 60% of the questions right on the old SAT Math, you would receive the same scaled score (out of 800) that you would receive if you got 60% of the questions correct on the new SAT Math. For example, from the chart you'll be able to see that getting 40% of right answers on the new and old SAT would get you a score of a little less than 500. However, because there’s no penalty for guessing and one fewer answer choice, students will get a greater percentage of questions right on the new test, if the tests are equally difficult. Most likely, this was a deliberate decision by the College Board. But why? There are a few possible reasons. The College Board may have wanted scores to be higher to raise satisfaction with the test. The redesign was motivated in part because the SAT was losing market share to the ACT. If students start to get higher scores on the SAT, that could motivate more students to opt to take the SAT vs. the ACT. Also, more states are adopting the SAT as a mandatory state test. Because all students in certain states will be taking the SAT as opposed to just college-bound students, scores from the old test and new test may become more equal over time. In addition to inflated scores, there's another scoring controversy that involves converting new SAT scores to ACT scores. Are the Concordance Tables Accurate? In early May, the College Board released concordance tables that allow students to convert old SAT scores to new SAT scores. These tables also allow you to convert old and new SAT scores to ACT scores. You can use our conversion tools that are based on these tables. While the ACT and College Board previously collaborated in 2006 to create a concordance table so students could convert old SAT scores to ACT scores and vice versa, the two groups didn’t work together on the recently released table that enables conversion of the new SAT scores to ACT scores. The CEO of the ACT, Marten Roorda, claimed that because the College Board didn’t collaborate with ACT on the table that the College Board’s table can’t be accurate. Furthermore, he stated that these tables are likely not to be accurate because they were released after only one test, and the old tables were created after a year’s worth of tests. Concordance tables are created using equipercentiling, which means that a 75th percentile score on one test is equivalent to a 75th percentile score on another. A 90th percentile score on the ACT is equivalent to a 90th percentile score on the new SAT. Roorda argued that there can’t be accurate percentile scores on the new SAT because there had only been one administration of the test when the tables were released, and the students who took the first test may not be representative of students as a whole. He claimed that a year’s worth of tests and data was needed before the College Board could effectively equipercentile. The College Board’s senior vice president for research, Jack Buckley, responded by stating that the concordance tables aren’t only based on the March 2016 SAT. There were â€Å"two large-scale national concordance studies in December 2014 and December 2015.† The College Board stands by its concordance tables. He also said that they had reached out to ACT to collaborate on the new concordance tables and that the College Board looks forward to working with ACT in the future. What Do These Controversies Mean for You? The squabbles between the ACT and the College Board won’t have much impact on you, but you should be aware that the new SAT scores are slightly inflated. Because there’s no better alternative, college admissions officers will likely use the College Board’s concordance tables, and you should do the same. If you take the SAT and the ACT, or if you’ve taken the old SAT and new SAT, you should send your best scores based on the concordance tables to colleges, if you have the option of selecting which scores to send. Also, if you’re trying to determine your target score for the SAT, use the concordance tables to convert old SAT scores to new ones. Colleges haven’t released their standardized test scores for the new SAT yet. We recommend that you strive to get a 75th percentile score for any college you want to attend. Use the concordance table to convert a school’s 75th percentile score on the old test to an equivalent score on the new one. What's Next? Are you planning on taking the new SAT? Find out what students who've taken the test thought about it. Did you know the essay on the new SAT is optional? Learn if you should take the essay. Did you get a high score on the old SAT? Read this post to find out if you should take the new SAT. Disappointed with your scores? Want to improve your SAT score by 160 points?We've written a guide about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now:

History Of Egypt Essays - Ancient Near East, Civilizations

History Of Egypt Essays - Ancient Near East, Civilizations History Of Egypt The Egyptians had never willingly submitted to the rule of their Semitic shepherd kings and around 1600 A.D. a long patriotic movement got rid of these foreigners. Followed by a new phase or revival for Egypt, a period known to Egyptologists as the New Empire. Egypt, which had not been closely combined before the Hyksos invasion, was now a united country; and the phase of subjugation and insurrection left her full of military spirit. The Pharaohs became aggressive conquerors. They had now acquired the warhorse and the war chariot, which the Hyksos had brought to them. Under Thothmes III and Amenophis III Egypt had extended her rule into Asia as far as the Euphrates. We are entering now upon a thousand years of warfare between the once quite separated civilizations of Mesopotamia and the Nile. At first Egypt was ascendant. The great dynasties, the Seventeenth Dynasty, which included Thothmes III and Amenophis III and IV and a great queen Hatasu, and the Nineteenth, when Rameses II, supposed by some to have been the Pharaoh of Moses, reigned for sixty-seven years, raised Egypt to high levels of prosperity. In between there were phases of depression for Egypt, conquest by the Syrians and later conquest by the Ethiopians from the South. In Mesopotamia Babylon ruled, then the Hittites and the Syrians of Damascus rose to a transitory predominance; at one time the Syrians conquered Egypt; the fortunes of the Assyrians of Nineveh ebbed and flowed; sometimes the city was a conquered city; sometimes the Assyrians ruled in Babylon and assailed Egypt. Our space is too limited here to tell of the comings and goings of the armies of the Egyptians and of the v arious Semitic powers of Asia Minor, Syria and Mesopotamia. They were armies now provided with vast droves of war chariots, for the horsestill used only for war and gloryhad spread by this time into the old civilizations from Central Asia. Great conquerors appear in the dim light of that distant time and pass, Tushratta, King of Mitanni, who captured Nineveh, Tiglath Pileser I of Assyria who conquered Babylon. At last the Assyrians became the greatest military power of the time. Tiglath Pileser III conquered Babylon in 745 B.C. and founded what historians call the New Assyrian Empire. Iron had also come now into civilization out of the north; the Hittites, the precursors of the Armenians, had it first and communicated its use to the Assyrians, and an Assyrian usurper, Sargon II, armed his troops with it. Assyria became the first power to expound the doctrine of blood and iron. Sargons son Sennacherib led an army to the borders of Egypt, and was defeated not by military strength but by the plague. Sennacheribs grandson Assurbanipal (who is also known in history by his Greek name of Sardanapalus) did actually conquer Egypt in 670 B.C. But Egypt was already a conquered country then under an Ethiopian dynasty. Sardanapalus simply replaced one conqueror by another. If one had a series of political maps of this long period of history, this interval of ten centuries, we should have Egypt expanding and contracting like an amba under a microscope, and we should see these various Semitic states of the Babylonians, the Assyrians, the Hittites and the Syrians coming and going, eating each other up and disgorging each other again. To the west of Asia Minor there would be little Egan states like Lydia, whose capital was Sardis, and Caria. But after about 1200 B.C. and perhaps earlier, a new set of names would come into the map of the ancient world from the northeast and from the northwest. These would be the names of certain barbaric tribes, armed with iron weapons and using horse chariots, which were becoming a great affliction to the Egan and Semitic civilizations on the northern borders. They all spoke variants of what once must have been the same language, Aryan. Round the northeast of the Black and Caspian Seas were coming the Medes and Persians. Confused with these in the records of the time were Scythians and Samatians. From northeast or northwest came the Armenians, from the northwest of the sea-barrier through the Balkan peninsula came Cimmerians, Phrygians

How To Lose Weight Without Feeling Deprived Article

How To Lose Weight Without Feeling Deprived - Article Example With this said, I would like to set a different kind of sustainable weight loss program that would last and even motivate me to do more without having to feel deprived. My game plan would be best laid down through the use of the S.M.A.R.T strategy. Specific: I would like to set a program that will make me reach my ideal weight which is 115 pounds as proportionate to my height and at the same time feel stronger, increase my agility, and develop a leaner body. I would start making this happen by talking to a professional gym trainer to assess my body and develop a customized program considering my fitness goals. The gym that I would choose to enroll in would be one that offers different classes as well, as I am inclined to dancing, zumba, and yoga. This I believe would not only be a strong motivational factor to go to the gym but at the same time would exercise all parts of my body. Measureable: Based on my experience in going to the gym, one would need to look forward to something or encouraged along the journey for one to want to keep going. One of the techniques to do so would be to measure the success one is making to get one excited and to keep the routine going. In my case, I would want to measure the body fat that I am losing instead of measuring my weight. This is because of the fact that some people may weight more than others but does not necessarily mean they are healthier. Since ultimate health is my utmost goal it would be best to measure how much fat I lost. Aside from that, I would also like to measure the level of commitment I give to working out by simply counting how many days I would miss in my MWF workout schedule. I would be able to know if I have already reached my fitness goals by constantly checking with the weighing scale and using the BMI calculator. Â  

Bioethic issue Assignment Example | Topics and Well Written Essays - 250 words

Bioethic issue - Assignment Example Hence, the controversy centers on the moral implication of interrupting with the human embryos. The religious groups regard the destruction of the embryo as abortion. The group holds that embryo forms life, and it is unethical and immoral to interfere with life. Similarly, the politicians argue that the use of stem cells is a devaluation of the human life (Gold 1). In this respect, the furtherance of the research will enhance the destruction of human life. Likewise, a section of scientists contends that the current practice of using adult stem cells in therapies is enough. Thus, the opponents believe that a need does not exist to warrant the scientists to carry out researches using embryonic stem cells. Research on the embryonic stem cells is not ethical and immoral as perceived by the public. The public should understand that embryonic stem cell has the potential of introducing new treatment of some of the costly diseases. In effect, the cost of many diseases in terms of suffering and monetary aspects implies the ethical concerns raised by the public are inadequate to discontinue the promising therapy. The legal abortion is the source of embryos, and thus the public should not view stem cell research as unethical. Therefore, the public should have a balanced view of the stem cell