ARTICLES

ARTICLES

I have both good news and bad news regarding articles.

Let me give you the good news first.  There are only three articles in English language:  a, an, and the.

Here,  the indefinite articles are “a” and “an.” The definite article is “the.

The bad news is that their proper use is complex, especially when you get into the advanced use of English. Quite often you have to work it out by what sounds right, which can be frustrating for a learner. You also need to know when not to use an article.

The Indefinite Article

A and an are the indefinite articles. They are used before singular nouns that introduce something or someone you have not mentioned before.

They are really the same article, but we say 'a' when the noun we are referring to begins with a consonant, or consonant sound (b, c, d, f, g, h, j, k, l, m, n, p, q, r, s, t, v, w, x, y or z)

• "a city" [si-tē]
• "a factory" [ˈfak-t(ə-)rē]
• "a university" [yü-nə-ˈvər-sə-tē]

Did you notice how the article is pronounced? - "ə" - Yes, it's the schwa again!

You might hear it pronounced "eɪ", we do that when the article is stressed.

For example:-

"I said you could have a gummy bear, not two!"

You use 'an' when the noun you are referring to begins with a vowel, or vowel sound:

• "an apple" [ˈa-pəl]
• "an elephant" [ˈe-lə-fənt]
• "an hour" [ˈau̇(-ə)r]

It's really the sound that matters, not the spelling, and if an adjective gets in the way, it takes over from the noun.

For example:-

My husband sent me an SMS.

My husband sent me a nice SMS.

(Lots of people get this wrong - including native speakers.)

We also use the indefinite article when talking about our profession.

For example:-I'm a teacher, but I prefer to think of myself as an English helper.

The Definite Article

We use' the' when we are talking about a particular thing, or we have already mentioned the thing we are talking about.

For example:-

This is the information about the definite article.

We also use it to talk about geographical points on the globe, some countries, rivers, oceans, seas, and before certain nouns when we know there is only one of a particular thing.

'The' is also used to form the superlative.

For example:-

What is the best way to learn English?

There are two ways to pronounce "the".  One is "thə" and the other "thee".

No Article

We do not need an article to talk about things in general.

'The' does not mean all.

For example:

  "The books are expensive."  (Not all books are expensive, just the ones I'm talking about.)

  "Books are expensive."   (All books are expensive.)

Inflation is rising. People are worried about rising crime. (Note! People generally, so no article)

You do not use an article when talking about sports.

Example:  My son plays football.   Tennis is expensive.

You do not use an article before uncountable nouns when talking about them generally.

Example:

Information is important to any organisation.   Coffee is bad for you.

You do not use an article before the names of countries except where they indicate multiple areas or contain the following words: state(s), kingdom, republic, union...

Example:

No article - Italy, Mexico, Bolivia, England  Use the - the UK (United Kingdom), the USA (United States of America), the Irish Republic Multiple areas! the Netherlands, the Philippines, the British Isles

Summary                   

When you look at all the variables, I think you will agree that you need to develop a feeling for articles.

Quite often you have to work out what is correct by what sounds right, which can be frustrating for a learner, but it's an important aspect of learning English.

Don't worry about it too much. If you work on it, and practise lots, pretty soon you will know the right article to use.

Two Staging Systems for Chronic Lymphoid leukemia

TWO STAGING SYSTEMS FOR CCL

Rai staging system for chronic lymphoid leukemia

The Rai staging system is one of the two staging systems currently adopted in assessment of chronic lymphocytic leukemia(CLL).
It comprises of stages 0 to IV and classifies chronic lymphocytic leukemia into low, intermediate and high-risk categories, which correspond with stages 0, I & II, and III & IV, respectively:

• Rai stage 0:
• low risk 
• lymphocytosis: a high lymphocyte count defined as more than 15,000 lymphocytes per cubic millimeter (> 15,000/mm³)
• Rai stage I:
• intermediate risk 
• lymphocytosis + lymphadenopathy.
• Rai stage II:
• patients are also intermediate risk 
• lymphocytosis plus an enlarged liver (hepatomegaly) or enlarged spleen (splenomegaly), with or without lymphadenopathy
• Rai stage III:
• patients are high-risk 
• lymphocytosis plus anemia with or without lymphadenopathy, hepatomegaly, or splenomegaly
• Rai stage IV:
• high-risk 
• lymphocytosis + thrombocytopenia (< 100-103 /dL)

 

Binet staging system for chronic lymphocytic leukemia

The Binet staging system is one of the two staging systems currently adopted in assessment of chronic lymphocytic leukemia(CLL).
It classifies CLL according to the number of lymphoid tissues that are involved (i.e. the spleen and the lymph nodes of the neck, groin, and underarms), as well as the presence of anemia or thrombocytopenia

• stage A: 
• fewer than three areas of enlarged lymphoid tissue 
• no anemia
• no thrombocytopenia
• * lymphadenopathy in the neck, axillary, inguinal as well as the splenic involvement, are each considered as "one group," whether unilateral (one-sided) or bilateral (on both sides)
• stage B:
• three or more areas of enlarged lymphoid tissue 
• no anemia 
• no thrombocytopenia
• stage C:
• patients have anemia and/or thrombocytopenia regardless of lymphadenopathy

USAGE OF QUOTATION MARKS

                                               USAGE OF QUOTATION MARKS




Quotations can bring your writing to life―the reader imagines someone saying the words―but quotations are also vexing to format.  Not only do you have to follow different rules depending on what other punctuation marks you mix with your quotation marks, but people in different countries also follow different rules.  In Medical transcription, the follows rules can be remembered with ease.....

Quotation Marks with Semicolons, Colons, and Dashes

First, let’s review the easy (but rare) stuff: semicolons, colons, and dashes always go outside quotation marks:

Bob snorted and said, “I don’t believe in zombies”―right before thirty of them emerged from the tunnel.

Her favorite song was “Gangnam Style”; she spent weeks trying to learn the dance.

She sang her favorite line from “I Don’t Wanna Stop”: “You’re either in or in the way.”

Quotation Marks with Question Marks and Exclamation Points

Stepping up the ladder of quotation-mark complexity, we find question marks and exclamation points: where they go depends on your sentence. If the question mark or exclamation point is part of your quotation, it stays inside; but if the question mark or exclamation point are not part of the quotation, they go outside the closing quotation mark.
In the next examples, the terminal punctuation is part of the quotation, so it stays inside the final quotation mark:

Reynold asked, “Can we have ice cream for dinner?”

Mom snapped and shouted, “No, we cannot have ice cream for dinner!”

On the other hand, in these examples, the terminal punctuation is not part of the quotation―it applies to the whole sentence―so it goes outside the final quotation mark:

Do you actually like “Gangnam Style”?

I can’t believe you lied to me about the ending of “The Sixth Sense”!

Quotation Marks with Commas and Periods

The most common question people ask about quotation marks is whether periods and commas go inside or outside, and the answer depends on where your audience lives because in American English we always put periods and commas inside quotation marks, but in British English periods and commas can go inside or outside (kind of like the American rules for question marks and exclamation points). I use this memory trick: Inside the US, inside the quotation marks. Here are some examples:

“Don’t underestimate me,” she said with a disarmingly friendly smile.

I can never remember how to spell “bureaucracy.”

EYE PRESCRIPTION INFORMATION

                                                      EYE PRESCRIPTION INFORMATION

Your prescription provides us with the necessary information to fabricate your eyeglasses correctly.  Below is a sample of the most common type of prescription that doctors use.

1.    DV is an abbreviation for Distance (dist.).

2.    NV is an abbreviation for Reading (near).

3.    CYL is an abbreviation for Astigmatism (cylinder).  Some prescriptions are written in (-) cylinder and some are written in (+) cylinder.  If your doctor omitted this information, please leave it blank when submitting your order.

4.    Reading-only eyeglasses: Some prescriptions are written separately for reading or in its entirety (as “NEAR”, “NV” or “NVO”).  For reading-only prescriptions, enter the numbers exactly as they are on your prescription and check “Reading” for lens type when ordering.

5.    Prescription Abbreviations and Definitions
a) OD = right eye
b) OS = left eye
c) OU = both eyes
d) PL = PLANO; a placeholder for the number zero
e) SPH = SPHERE power; the (total) power
f) DS = diopters sphere (you have sphere power only)
g) CYL = CYLINDER power;  the amount of astigmatism correction
h) X = axis; X 80 or AXIS 080
i) ADD = the amount of power that gets added to the distance prescription (this creates your reading-only prescription) or for the lower portion of your bifocals/progressives.
j) NV = near-vision (your prescription is for reading only)
k) PD = pupillary distance (the measurement in millimeters (mm) between both pupils)
l) -75 = -0.75
m) +125 = +1.25

6.    Your prescription may be written out on a blank Rx pad instead of a pre-made Rx pad for eyeglasses only.  The top number is the prescription for the right eye and the bottom number is the prescription for the left eye.

7.    If there are no numbers for CYL, AXIS or ADD in your prescription, do not enter anything in these fields when ordering.  When only one number appears for each eye, it is for the sphere power only.

8.    Occasionally, the numbers in your prescription will not include decimal points.  This means that +1.25 = +125 and -0.75 = -75.  Also, an axis of 80 = 080 and 6 (or 06) = 006.

9.    For some prescriptions there will be no astigmatism correction for one or both eyes.  Your doctor may just write the sphere power alone, or may use abbreviations like sph (“sphere”) or DS (“diopters sphere”).

10.    If there is only one ADD power on your prescription for bifocals, this means that the same ADD power is used for both eyes.  If there is no ADD power given, leave this section blank when ordering.

11.    Pupillary Distance (PD)
Pupillary Distance is the distance from the center of the pupil (black circle) in one eye to the center of the pupil in the other.
            

     Pupillary Distance measuring instructions:
1. Put the millimeter ruler on the bridge of your nose.

2. Ask someone to stand approximately 2 feet away from you and measure the distance between the centers of your pupils (the black circle in your eyes). 

3. You can measure pupillary distance yourself by using a mirror.
You may ask your doctor or a licensed Optician to obtain this information from your file or they can take the measurement for you.

Note:  Typical adult’s pupillary distance measurements are as follows:  (54mm to 66mm).
           Typical children’s pupillary distance measurements are as follows:  (41mm to 55mm).

RANGE OF MOTION MEASUREMENTS

Recently when I was auditing a file, I came across a blunder where ankle dorsiflexion was typed as 0 degrees to 200 degrees, which is just impossible.  The MT and the QC just had no idea what the dictator was dictating.  This prompted me to post the below article for ready reference.

Normal Range of Motion:

All joint Range of Motion measurements must be made using a goniometer.

For example, if the veteran lacks 10 degrees of full knee extension and has normal flexion, show the range of motion as extension to minus 10 degrees (or lacks 10 degrees of extension) and flexion 10 to 140 degrees.

1. Hip range of motion: (Movement of femur as it rotates in the acetabulum.)

a. Normal range of motion, using the anatomical position as zero degrees.

       

Flexion = 0 to 125 degrees (To gain a true picture of hip flexion, i.e., movement between the pelvis and femur in the hip joint, the opposite thigh should be extended to minimize motion between the pelvis and spine.)

Extension = 0 to 30 degrees.

Adduction = 0 to 25 degrees.

Abduction = 0 to 45 degrees.

External rotation = 0 to 60 degrees.

            Internal rotation = 0 to 40 degrees.

2. Knee range of motion:

a. Normal range of motion, using the anatomical position as zero degrees.

Flexion = 0 to 140 degrees.

Extension - zero degrees = full extension. Show loss of extension by describing the degrees in which extension is not possible. (e.g., Show range of motion as extension to minus 10 degrees and flexion 10 to 140 degrees when full extension is limited by 10 degrees and full flexion is possible.)

b. Stability.

Medial and Lateral Collateral Ligaments:  Varus/valgus in neutral and in 30 degrees of flexion - normal is no motion.

Anterior and Posterior Cruciate Ligaments:  Anterior/posterior in 30 degrees of flexion with foot stabilized - normal is less than 5 mm. of motion (1/4 inch - Lachman's test) or in 90 degrees of flexion with foot stabilized - normal is less than 5mm. of motion (1/4 inch - anterior and posterior drawer test).

Medial and Lateral Meniscus: Perform McMurray's test.

3. Ankle range of motion:

a. Neutral position is with foot at 90 degrees to ankle. From that position, dorsiflexion is

0 to 20 degrees; plantar flexion is 0 to 45 degrees.

b. Describe any varus or valgus angulation of the os calcis in relationship to the long axis

of the tibia and fibula.

4. Shoulder, elbow, forearm, and wrist range of motion:

a. Normal range of motion is measured with zero degrees in the anatomical position except for 2 situations:

i. Supination and pronation of the forearm is measured with the arm against the body, the elbow flexed to 90 degrees, and the forearm in mid position (zero degrees) between supination and pronation

ii. Shoulder rotation is measured with the arm abducted to 90 degrees, the elbow flexed to 90 degrees, and the forearm reflecting the midpoint (zero degrees) between

internal and external rotation of the shoulder.

b. Shoulder forward flexion = zero to 180 degrees.

c. Shoulder abduction = zero to 180 degrees.

d. Shoulder external rotation = zero to 90 degrees.

e. Shoulder internal rotation = zero to 90 degrees.

f. Elbow flexion = zero to 145 degrees.

g. Forearm supination = zero to 85 degrees.

h. Forearm pronation = zero to 80 degrees.

i. Wrist dorsiflexion (extension) = zero to 70 degrees.

j. Wrist palmar flexion = zero to 80 degrees.

k. Wrist radial deviation = zero to 20 degrees

l. Wrist ulnar deviation = zero to 45 degrees.