ESL Learners Test Preparation

Its important to prepare well for big tests - especially for exams like the TOEFL, IELTS or Cambridge First Certificate (FCE). This guide will help you take steps towards doing your very best on the big day. Know Your Test First things first: Find out about the test! Reading test-specific preparation materials will help you understand your strengths and weaknesses on specific topic areas covered in the test. Understanding which types of problems are easiest and which are most difficult will help you develop a study plan for the test. While developing your plan, take note of grammar, vocabulary, listening, speaking and writing expectations. Also, take note of specific exercise types on your exam. Preparing for the TOEFLPreparing for the First Certificate ExamPreparing for the IELTS Practice, Practice, Practice Once you have established a study plan, youll need to do lots of practice. Practice begins with understanding the subjects that will be included in reading, writing and listening. If youre not taking a course, using advanced level resources at this site can help you study up and practice grammar, build vocabulary, as well as improve writing techniques and listening skills. Advanced Grammar ResourcesAdvanced Writing ResourcesAdvanced Vocabulary Resources Practice Specific Types of Test Problems So youve studied up on your grammar, writing, and vocabulary, now youll need to apply these skills to specific types of exercises you will find on your exam. There are a number of free and paid resources available on the Internet. Cambridge Exams Practice Materials Take Practice Tests After you have become familiar with the types of exercises on your test, youll want to practice taking the test as often as possible. For this purpose, the best thing to do is purchase one of the many books that provide practice tests for the TOEFL, IELTS or Cambridge Exams. Top TOEFL Study MaterialsTop First Certificate Study Materials Prepare Yourself - Test Taking Strategy Shortly before the big day, youll also want to spend some time developing specific test taking skills. These skills include strategies on multiple choice questions, timing, and other issues. Effective Test Taking Strategies Prepare Yourself - Understand the Test Structure When you understand the general techniques required to do well on a test, youll also want to study specific exercise techniques to help you develop a strategy for each type of question. These links focus on specific exercises that youll find on the Cambridges First Certificate Exam. However, these types of exercises are found on most of the major exams in one form or another.

The Conflict Between Good And Evil - 1426 Words

Notions of good and evil appear in every social sphere of influence and each serve an influential role in how humanity interacts within itself. Shakespearean works often rely on a wrongful act being corrected, a specific moral dilemma that often revolves around themes of death. Shakespeare’s tragedy ‘Hamlet’, akin to Macbeth in tragic scope, explores the idea of morality as well as how it impacts the lives of each character, but is Hamlet a play about the conflict between good and evil? Hamlet delves into the notions good and evil by focusing on the spheres of politics, personal relationships and religion. Claudius’ rise to power in Denmark, as well as how he chose to use his power and the end of his rule are depictions of political and†¦show more content†¦However, now that he knows that Hamlet is coming back from England, Claudius takes a different approach to the situation. He decides to tell Laertes that Hamlet killed his father and essentially goads Laertes into killing Hamlet for him. Closely related to Claudius’ manoeuvring is him sending Hamlet to England in the first place. â€Å"Our sovereign process; which imports at full, By letters conjuring to that effect, The present death of Hamlet.† (4.3, 64-66) Instead of dealing with the problem of Hamlet himself, Claudius lies to Hamlet about his going to England for safety: what Claudius actually intends is for Hamlet to be killed there. Ultimately, the immoral and unnatural acts committed by Claudius politically enable evil to infiltrate the lives and morals of the other characters, Hamlet in particular. Although Claudius actively worked against Hamlet, Hamlet himself was not immune to immoral behaviour. In fact, Hamlet has caused much undue hardship and even death to many of the characters, but he caused the most pain to Ophelia. Throughout their tempestuous relationship, Hamlet treated Ophelia poorly and even continued to do so once the relationship was over. â€Å"IShow MoreRelatedThe Conflict Between Good And Evil Essay1611 Words   |  7 Pages Since the rise of storytelling, one of the most important themes has been the conflict between good and evil. Often, audiences could gauge whether a character was going to be virtuous or villainous based on their role in society. Princes, kings, knights, these were the â€Å"good† characters. Tax collectors, witches, and other scoundrels were quite obviously evil. In modern times, the public generally considers law enforcement officers to be on the side of righteousness. However, we expect charactersRead MoreGood vs. Evil Found in Beowulf807 Words   |  3 PagesGood vs. Evil Found in Beowulf In the story of Beowulf, there are many different themes found. Many people argue the main theme found in this story. This has been argued for a very long time and will go on for many more years to come. Although many themes in this story stick out and a main theme will never be accepted, one main theme is very noticeable in the story of Beowulf. The main theme found in Beowulf is good versus evil. Good versus evil is very easy to recognize. â€Å"Some peopleRead MoreGood Versus Evil in Lord of the Flies by William Golding Essay1235 Words   |  5 PagesGood vs. Evil Many years ago, Charles Darwin introduced a theory that we humans are a species which evolved from animals that have inhabited the Earth for many years, and he believed that we were civilized, intelligent, and logical life forms for these very reasons. In the novel, Lord of the Flies by William Golding there is a prominent theme of good versus evil which reveals that maybe humans are not the civilized human beings that they were said to be. William Golding carefully netted this themeRead MoreEssay Good Vs. Evil - Analytical Sentence Outline569 Words   |  3 Pages Theme: Good and Evil Create a SocietyParagraph 1:CENTRAL IDEA: Conflicts heavily arise between the two topics of good and evil. THESIS SENTENCE: Through common stories good and evil are portrayed through both protagonist and antagonist view, creating morals and opinions, and how societies views have changed over time. Paragraph 2:TOPIC SENTENCE: Common stories portray good and evil through both a protagonist and antagon ist view.Paragraph 3: TOPIC SENTENCE: Significant morals and opinions are shownRead MoreEssay about Critique of The Play Foxfire686 Words   |  3 Pageseventually must choose to either leave the home she had know for so many years to go live with her son and grandchildren or to stay there alone with Hector. I believe that the genre of this play was a mix between tragedy and melodrama. Although there were not exactly and conflicts of good versus evil, the story proved to be somewhat serious. They were rewarded in the end it seemed because everyone got what they wanted: Prince Carpenter was eventually able to buy the land, Dillard got his mother toRead More Conflict between Good and Evil in Bradstreet’s The Flesh and the Spirit1355 Words   |  6 PagesConflict between Good and Evil in Bradstreet’s The Flesh and the Spirit  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚      A colonial Puritan minister, Thomas Shepard, nicely summarized the paradox of the Puritan religion when he noted that â€Å"The greatest part of Christian grace lies in mourning the want of it.†Ã‚   Shepard suggests, in this passage, that good Christians should spend their days, indeed their entire lives, exploring and proclaiming their own depravity and sinfulness, their â€Å"want† of Christian grace.   Paradoxically, onlyRead MoreMacbeth as a Play About the Conflict Between Good and Evil Essay2248 Words   |  9 PagesPlay About the Conflict Between Good and Evil Macbeth is a tragedy, which addresses the inner conflict of peoples morality. Furthermore, it appears Shakespeares intention was to portray the modern day attitudes towards religion and the supernatural of his time. Indeed, the Elizabethan audience the play was written for would have been devout Christians, and would have had strict beliefs towards good and evil. The audience was genuinely afraid of evil, and it wasRead MoreGood And Evil : Dr. Faustus1228 Words   |  5 Pagestheme of good versus evil is one of the most apparent as well as one of the most important themes throughout the play. Good and evil are represented as a battle or struggle in many ways such as constantly battling over winning various individuals souls, the concept of God versus the Devil, and the idea of religion versus science. This war between good and evil creates both internal conflicts for Faustus along with the external conflict between Faustus and various characters. The struggle between goodRead MoreTheme Of Good And Evil In Beowulf1190 Words   |  5 PagesIn the beginning all was good; there was no evil. The start of evil was marked when a jealous angel, Satan, desired equality to God. He thrust an ever-lasting battle into play when he battled God for supremacy. One-third of all the angels in heaven, including Satan, were thrown from heaven onto Earth. God’s perfect creation became faulted whe n the fallen angel, Satan, tempted Adam and Eve into eating a forbidden fruit. By partaking of the forbidden fruit, sin was born on Earth. The birthing of suchRead More John Steinbecks East of Eden - Good Versus Evil Essay980 Words   |  4 PagesGood Versus Evil in East of Eden    The idea of good versus evil is illustrated in several ways in John Steinbecks East of Eden. This is seen through the external conflicts in the novel, the internal conflicts of the characters, and a universal understanding of the battle between good and evil.    External conflicts between the main characters, Cathy and Adam, reflect the idea of good versus evil in their relationship. Cathy, who is much like Satan, creates a huge fight between Adam

Epidural Catheterization In Cardiac Surgery Health And Social Care Essay Free Essays

Introduction: Risk-benefit-ratio rating of extradural haematomas due to catheter arrangement in patients undergoing cardiac surgery is still controversial. The intent of this survey is to update to 2012 the per centum of catheter-related extradural haematoma hazard in cardiac surgery. Methods: Bracco and Hemmerling 2007 hazard appraisal was updated by seeking all reported instances of extradural arrangement for cardiac surgery, in web and in literature, from April 2007 to September 2012. We will write a custom essay sample on Epidural Catheterization In Cardiac Surgery Health And Social Care Essay or any similar topic only for you Order Now Hazards of other medical and non-medical activities were retrieved from recent reappraisals or national statistic studies. Consequences: Hazard of catheter-related extradural haematoma is 1/5,493, with a 95 % CI of 1/970 to 1/31,114. It is similar to the hazard in the general surgery population of 1/6,628 ( 95 % CI 1/1,170 to 1/37,552 ) . Decisions: Hazard of catheter-related extradural haematoma should be considered acceptable, since it is comparable to the hazard of deceasing in a auto accident, which is a jeopardy widely accepted. Its usage should be encouraged, because extradural improves recovery in patients undergoing cardiac surgery. Introduction In cardiac surgery, the extradural anesthesia/analgesia technique has been performed for many old ages [ 1 ] ; however, its usage is frequently limited by the fright of increased hazard of extradural haematoma associated with anticoagulation therapy. The risk-benefit ratio of medical processs needs to be known in order to do the best pick in routinely clinical pattern. In peculiar, it is of import to better look into the hazard benefit-ratio of extradural catheter in cardiac surgery, since it is a controversial and strongly debated pattern. In a recent reappraisal [ 2 ] , Royse showed the benefits and hazards related to high pectoral extradural anaesthesia, and he concludes that amp ; acirc ; ˆ?epidural usage in cardiac surgery is no more unsafe than in non cardiac surgery A ; acirc ; ˆA? . Previously, Bracco and Hemmerling estimated hazard of catheter-related extradural haematoma, seeking databases from 1966 to March 2007 [ 3 ] . The deliberate hazard was 1 extradural haematoma out of 12,000 extradural catheterisation reported in literature. The purpose of this survey is to update to 2012 the per centum of catheter-related extradural haematoma hazard in cardiac surgery. Method Medline, SciSearch Embase, Google and Google Scholar were searched to choose publications showing patients undergoing cardiac surgery who received extradural anesthesia/analgesia. The hunt standards were ( ( ( ( extradural anaesthesia ) OR extradural catheter ) OR locoregional anaesthesia ) OR extradural ) AND ( ( ( ( cardiac surgery ) OR coronary arteria beltway grafting ) OR aortal valve surgery ) OR mitral valve surgery ) . Databases were explored from April 2007 to September 2012. The compiled publication list includes: conference abstracts, randomized control tests, retrospective and prospective surveies, and meta-analysis. The figure of patients undergoing cardiac surgery who received extradural catheterisation was retrieved ; attending was paid to non number patients twice. After that, the entire figure of instances ( denominator ) was calculated summing instances from April 2007 to September 2012 with instances from 1966 to March 2007 ; the latters were already included in th e appraisal hazard done by Bracco and Hemmerling [ 3 ] . The numerator was calculated adding instances of extradural haematoma after extradural catheterisation in cardiac surgery, occurred from 1966 to 2012. The hazard of catheter-related extradural haematoma was compared with several different hazards, such as: the hazard of catheter-related extradural haematoma in non cardiac surgery, the hazard of chest or prostate malignant neoplastic disease, and the hazard of route traffic hurt. The per centums of hazard used for comparing were extrapolated from big tests, meta-analysis or national statistics studies. As already done by Bracco and Hemmerling, the Wilson method [ 4 ] was used to cipher 95 % reversible assurance interval ( CI ) of a individual proportion. The comparing between 2 proportions was done utilizing the same method [ 5 ] . Consequence In 2012, the hazard of catheter-related extradural haematoma in cardiac surgery is 3 instances out of 16,477 patients, or 1/5,493, with a 95 % CI of 1/970 to 1/31,114. From April 2007 to 2012, around 4,477 patients having merely extradural or extradural plus GA and undergoing cardiac surgery were found. This population besides includes some paediatric patients. Kind of surgery and figure of patients are shown in table 1. We summed our consequences with the one estimated by Bracco and Hemmerling ; hence, the denominator is 16,477 ( 12,000 + 4,477 ) . Merely two instances of catheter-related extradural haematoma are described in literature from April 2007 to 2012. The first one occurred in 2010 and is reported by the UK Medical Protection Society [ 6 ] . A 70-year-old adult female had to undergo alteration surgery after 6 old ages since she received a ternary coronary arteria beltway. The twenty-four hours of surgery extradural catheter was placed without incident, and so GA was induced. The twenty-four hours after surgery, in the forenoon, the patient showed initial neurological symptoms, noticed by a nurse. However, her spinal column was examined through a CT scan merely hours subsequently, after neurological scrutiny revealed an intense motor and centripetal bilaterally block at the T6 degree. A big haematoma in the extradural infinite was clearly seeable ; hence, an exigency laminectomy and emptying of haematoma were performed. This patient remained paraplegic. The 2nd instance of catheter-related extradural haematoma happened in 2011 [ 7 ] . On the twenty-four hours of surgery, after GA initiation an extradural catheter was placed. The patient was a 55-year-old adult male scheduled for mitral valve replacing and tricuspid annulate plasty, who had stopped warfarin 7 yearss earlier surgery. Preoperative blood test revealed a normal curdling profile and normal thrombocyte count. A flaccid paraplegia appeared 16 hours after the terminal of surgery ; at that clip his curdling profile was altered and he had besides thrombocytopenia. An exigency magnetic resonance imagination showed an extradural haematoma at the T5-T6 degree, hence a laminectomy, within 6 hours since symptoms onset, was instantly performed to take the haematoma. This patient had a good overall recovery, and presented merely a little dysuria 6 months after laminectomy. Bracco and Hemmerling identified merely one instance of catheter-related extradural haematoma occurred in 1995 and subsequently reported in 2004 [ 8 ] ; hence, this instance adds up to the 2 antecedently described, so the numerator for the hazard assessment up to 2012 is represented by 3 instances. Several instances of neurological complications happening in patients with an extradural catheter placed for cardiac surgery are described in literature. Arora et Al. reported a instance of pneumocephalus after extradural anaesthesia [ 9 ] . The patient was a 68-year-old hypertensive, diabetic and corpulent male admitted for a coronary arteria beltway surgery ( CABG ) . He had a moderate clogging pneumonic disease, so extradural anaesthesia was proposed, obtaining informed consent. After uneventful extradural catheter interpolation, the trial dosage was administered ( 2ml of 2 % Lidocaine ) . Immediately, the patient reported a terrible concern, and so generalized tonic clonic ictuss developed. The patient gained consciousness 10 proceedingss subsequently, after ictuss were controlled. The magnetic resonance imagination showed air in the basal cisterns and subarachnoid infinites. The patient got a full recovery and underwent surgery 2 yearss subsequently. Writers concluded that the c omplications were due to the puncture of the dura mater. The hazard of catheter-related extradural haematoma in cardiac surgery is comparable to the hazard of extradural haematoma after regional techniques for general surgery [ 10, 11 ] . Volk et Al. estimated an incidence of spinal haematoma of 1: 6,628 in general surgical population, in Germany, from 2008 to 2009. We calculated a comparative hazard decrease of 17 % prefering general surgery ( non important ) . The US mortality for bosom disease ( deaths per population ) [ 12 ] is 10 times higher the hazard of extradural haematoma after extradural anesthesia/analgesia for cardiac surgery. The hazard of catheter-related extradural haematoma in cardiac surgery is 100 times lower than both the incidence of acute nephritic failure after CABG [ 13 ] , and the incidence of sternal lesion infection after CABG [ 14 ] . The hazard of catheter-related extradural haematoma in cardiac surgery is besides a 1,000 times lower than the frequence of ordering mistakes in infirmaries ( errors/admissions ) [ 15 ] . Patients undergoing cardiac surgery with an extradural catheter in topographic point have a hazard to develop an extradural haematoma comparable to the hazard of developing chest malignant neoplastic disease ( women/year ) or prostatic malignant neoplastic disease ( men/year ) [ 16 ] , and to the hazard of deceasing by accident ( deaths/population ) [ 17 ] [ Fig.1 ] . Discussion Knowing the hazard per centum related to medical processs is really of import in clinical pattern ; it permits to correctly measure the risk-benefit ratio and to explicate patients all is needed, in order to obtain an informed consent before executing processs. Two recent meta-analysis have shown, one time once more, that the usage of epidural over general anaesthesia in patients undergoing cardiac surgery improves recovery by diminishing: the incidence of acute nephritic failure, the incidence of postoperative supraventricular arrhythmias, the clip on mechanical airing and respiratory complications [ 18, 19 ] . Therefore, extradural anaesthesia is an of import intercession in the multimodal scheme that anesthesiologists actuate in order to vouch the best quality attention. Furthermore, wake up cardiac surgery is a new minimally invasive anaesthesia technique, and it is a cherished option for bad patients with terrible COPD ; because avoiding cannulation and mechanical airing is necessary to cut down the hazard of decease [ 20-25 ] . This survey demonstrates that the hazard of catheter related extradural haematoma in cardiac surgery is non zero, but it is a hazard that we consider to be acceptable, since it is comparable to the hazard of deceasing in a auto accident [ 26 ] , which is an jeopardy normally accepted [ Fig. 1 ] . Restrictions of the current hazard analysis are related to our determination of non sing differences among the surveies we used as beginning. Different times of catheter arrangement, different perioperative heparinization protocols and different puncture degrees are non taken into history. The increased hazard, compared to the 2007 appraisal by Bracco and Hemmerling, we believe is due to a lessening in the figure of instances we used to find the denominator, and non to a existent addition in instances of catheter-related extradural haematoma. We used as denominator the figure of patients who received an extradural catheterisation to undergo cardiac surgery. It is our sentiment, that the instances reported in literature in recent old ages are merely a little proportion of the figure of extradural catheter arrangement really performed. Furthermore, the attending paid to epidural-related jobs has increased over clip, and accordingly, the demand to describe incorrect events increased. In literature, instances of self-generated extradural haematoma without an extradural catheter after cardiac surgery are besides described. For case, Hayashi et Al. [ 27 ] reported about a 71-year-old adult females, who underwent mitral valve plasty with CPB. The surgery lasted around 4 hours uneventfully, and she was non antecedently treated with anticoagulant therapy neither with extradural. One hr after surgery, paraplegia was apparent, an extradural haematoma compacting spinal cord at the C7-T4 degree was revealed through magnetic resonance imagination. A conservative attack was chosen because the paraplegia was non progressive. The writers stated that the extradural haematoma etiology was non apparent. The adult female had good overall result. In decision, measuring the risk-benefit ratio of utilizing pectoral extradural anaesthesia in cardiac surgery should be easier, thank to this update hazard appraisal. How to cite Epidural Catheterization In Cardiac Surgery Health And Social Care Essay, Essay examples