Rhetorical Analysis Essay

Al Gore’s An Inconvenient Truth: Rhetorical Analysis In Al Gore’s An Inconvenient Truth, he focuses on the harm global warming does to our planet. He wants to persuade people that global warming is real, and that they should contribute to the effort of slowing, even completely stopping, global warming. Gore uses a variety of ways to appeal to pathos and logos. One of the first things he does, is explain global warming, he them proceeds to show a short, funny cartoon to describe global warming. While this short is not exactly accurate, and looks like it is taken from The Simpsons cartoon, it is comical, and he uses this short to intrigue his audience. After drawing us in, he keeps us attentive by sprinkling these little emotional holds into his argument. Gore tells us in the beginning about his son being hit by a car when he was five years old. This anecdote causes an overwhelming sense of sympathy and alarm but also wonder of how this relates to the argument. Then, Gore tells us tells us that the awful accident made his realize he wanted to do something important, wanted to do something to change the world, and that something was to spread the â€Å"global warning. †Almost fifty percent of the facts Al Gore uses also carry an emotional appeal, but they also are appealing to logos. Such as, if only half of Greenland and half of Antarctica melted water would cover so much land, including the 9/11 memorial, that the world maps would have to be redrawn, and he also tells us that global warming causes intense weather conditions, including hurricanes. Gore provides an audio track of a man describing hurricane reports that were coming in after making this point, and in the track the unknown man repeats â€Å"I can’t take it anymore, the water is up to my neck,† creating guilt in the audience. We contributed to that. Al Gore does a great job of presenting an appeal to pathos and logos. Al Gore uses more than just humor and anecdotes to relay information, however. He also uses expert testimony, and quantitative data by presenting a variety of charts, graphs, and pictures created by scientist, to prove his point. Gore uses a chart that shows how carbon dioxide and temperature correlate. When carbon dioxide rises, so does the temperature. At the time of the documentary, the carbon dioxide level was higher than it has ever been. He also uses a chart to show the ten hottest years in history, at that point in time, they all occurred within 14 years before. He places a higher thought of the two charts and other unmentioned, by saying that they were before unseen by the public. In addition to humor, anecdotes, expert testimony, and quantitative data to prove his point, he also throws just a few plain old facts at us. For example, Gore tells us that 200 towns and cities in the west have broken temperature records, and that science textbooks have had to be rewritten because it was before thought impossible for a hurricane to take place in the South-Atlantic, but then there was one. The hurricane was caused by warming of waters ocean wide. Al uses his variety of vehicles to present information to his advantage. While Al Gore does do a nice job of making his point, it would all be somewhat of a waist without established ethos. If he had no ethos, we would not take anything he said into consideration. When Gore introduces himself, he says, â€Å"I’m Al Gore and I used to be the next president of the United States. †Some people think that this may hurt him, but it is very untrue. He has to be a highly intelligent and well thought of man to run for president, and the votes were said to be â€Å"too close to count. Gore also establishes ethos through his dress; he is very well put together and professional. Al Gore has also written a book about global warming, and he would not be well enough equip to do so if he did not know a vast amount about it. This little piece of ethos helps him most to be taken seriously and for his audience to know that he knows what he is talking about. His audience is almost important to his ethos, and his audience is simply everyone in the world. Global warming is an issue for everyone who lives on this planet and Gore makes sure that he gets the word out. He even said that he knows that he has given his speech over one thousand times worldwide. Al Gore’s high level of ethos helps him to better appeal to the people of the world to spread the word on global warming. Al Gore was highly successful in furthering his message. When you take everything that he says and the methods he used to relay information, there is no doubt that he did. If he tells a small, or large, group of people about global warming, they are going to tell people they know about it and the word will spread. The way Gore gives his message was key. Everything he says is easy to follow and understand. He avoids anything that could cause confusion and backs up everything he says with something that correlates. For instance, the frog animation. Some people do not believe in global warming because it is gradual, but when you put a frog in water and slowly raise the temperature it also is unknowing. This example can turn skeptics into believers. Everything Al Gore says and does in his documentary adds to the success in thoroughly presenting his message. In Al Gore’s An Inconvenient Truth, he uses an appeal to people’s logos and pathos through various techniques to persuade his audience that global warming is here and harming. His high level of ethos and knowing his audience well helps him to be taken seriously on this matter and over all being successful in giving his message to the world.

Management of Human Service Programs essayEssay Writing Service

Management of Human Service Programs essayEssay Writing Service Management of Human Service Programs essay Management of Human Service Programs essayI have been in a situation where I have disagreed with my employer’s policies because I did not think that they served the best interests of persons asking for help.   I asked my employer to reconsider the policies and make considerable changes to meet the needs of clients. My employer agreed with me. I think that the following characteristics I would be able to cultivate in myself: perception, observation, data gathering, assessment; advanced active listening skills, ability to negotiate, ability to set and keep limits, ability to decide when to ignore and when to confront behavior, ability to intervene in problems and ability to teach, model, shape, instruct, clarify. I think I would have a great desire to become a human services supervisor because this job is interesting for me. The duties and responsibilities of a supervisor include overseeing the work of others. A human services supervisor should be ready to find the link betwee n the organizational expectations and the provision of human services. According to Judith Lewis and colleagues, â€Å"today’s human service supervisor must fulfill several roles and functions to ensure efficient and effective services†. I could serve as a human service supervisor, performing the roles of organizational leader and the functions of manager, mediator and mentor. As a manger, the human services supervisor should have enough knowledge and the proper skills in such areas as budgeting, planning, evaluation, etc. As a mediator, the human services supervisor should facilitate relationships with other employees in the organization. As a mentor, the human services supervisor should provide support to employees, improving their knowledge and enhancing the delivery of human services. I believe that I could implement these functions in a proper way.

Nutrition Research Paper Example | Topics and Well Written Essays - 1000 words

Nutrition - Research Paper Example A sustainable food system needs to address unsuitable consumption as well as unsuitable production since both of them contributes toward negative environmental and healthy impact. Nutritional Challenges Affecting Current Food System Epidemic rise chronic disease Nutrition transition has occurred and has led to increase of cases of chronic disease which include diabetics, cardiovascular diseases, and cancer. This is attributed to a large shift in both physical activity and food consumed. This shift is reflected in population by nutrition outcome such as stature and body composition changes (Kickbusch). The modern society has converged to â€Å"western diet† which is food with a high level content of sugar and saturated with fat also low in fibre content and this is the diet that is linked to chronic disease and degenerative effects (Ilona 14). Chapter four of the film highlights this scenario with a case of a family’s dilemma situation at the grocery store: due to father diabetic condition, the family is aware that a healthier diet with more fresh foods would be the most suitable for him, but they have choose from foods they can afford. As the film imply, people with low incomes are most likely to eat cheaper, processed foods, and thus more likely to suffer from obesity, Type 2 diabetes, and other diet-related health disease (Pollan). â€Å"We are taking risks with our health and the health of the natural world that are unprecedented.† Food shortage 70 percent of the poor in the world depend on agriculture for their livelihood. The current food system is not delivering enough food supply to world population. Pollan used a â€Å"plant’s eye view of the world† to explore how plants which is needed by human could be thought to have manipulated and domesticated us, rather than the other way around. Using the same hypothesis, he claims that corn has succeeded in â€Å"domesticating us† where the current food supply system has influenced destruction of their local system of farming through green house gas emission from strong economies, which contribute to, global warming ,which adversely affect, the farming system, though developed and developing countries are both victim of worsened food insecurity (Ilona16). Chapter nine of the film touches on some issues manifested by our current food system, including acute possibility of a world food shortage, the significant amount of energy that goes into food production, and the impacts of industrialized food on our health and the environment. The film points out that while the consumer may feel helpless in the face of these issues of the food system, the food system does not positively respond to consumer need. Food and water safety Through food and water, over 200 disease agent can be transmitted to various people in a population, but this food system safety issue does not receive priority it deserves compared to other infectious disease such as HIV/AIDs or tu berculosis. (Ilona 18) Chapter three of Food, Inc. focuses on one of the unexpected implication of our current food system: the occasional contamination of the food supply and the very real risks presented to the population. The film reflects on this problem by interviewing the mother of a child who died from E. coli contracted from eating a hamburger. At a global scale, there are about 1.8 million deaths caused by diarrhea

Midterm Essay Example | Topics and Well Written Essays - 3250 words - 1

Midterm - Essay Example This means that people and business organizations are on a continuous journey that requires them to experience various processes and practices consciously or unconsciously. In this case, business organizations are expected to be abreast of the changing factors that can affect their profitability and other management aspects. This paper examines the concept of change and how it can be used by organizations to create and enhance their effective performance and success. It focuses on a Chinese Company, Alibaba Holdings, which has navigated its path to reach its current levels of excellence in business performance. The company has recently been listed on the New York Stock exchange in a bid to remain competitive and enhance its market position (Lianna, Jessica & Ryan, 2014). Currently, the pace by which globalization has been taking toll on businesses has quickened tremendously. Business executives and owners have been increasing their call for flexibility, agility and innovativeness from various business functions (Robertson, 2006). This development is aimed at positioning businesses strategically to tackle the rising challenges in competition and other factors in the external and internal environment. Amidst all these persistent calls, one thing has often been largely ignored, that is, organizations are creatively designed in order to search for competitive advantages that are sustainable. In addition, the fact that stability in business practices is just not desirable and effective, but attainable as well, has been an issue buried deeply in managerial psyche, but has been bolstered by periods of practice and theory (Christopher & Edward, 2006). It is important to understand that the popularity that is often associated with efforts for process improvement that range from overall quality management to various kinds of sigma provides are enough evidence for

Social classes and education Essay Example | Topics and Well Written Essays - 500 words

Social classes and education - Essay Example Racial theorist Shelby Steele felt that racial discrimination determined their lack of effort to achieve what others do.(Ogbu) The other issue that needs attention in determining African-American children’s education is the methodology used for teaching. In a multicultural urban elementary school, black teachers in an attempt to explore the best instruction to serve the black students felt the necessity of the attitude of â€Å"I want the same thing for everyone else’s children as I want for mine,† in teachers.(Delpit, 1998) Rectifying the cultural hegemony in teaching and empowering children the freedom of expression and culture in learning and inculcating child-centered approaches were found to be some of the steps. One way of achieving this end is by reminding children about their power to shape meaning and rationale. J Anyon found out that pedagogical care and practice differed in schools of different social classes.(Anyon, 1980) He studied a total of five schools and found out that the first two which were working class’ schools emphasized on rote behavior, gave less explanation and used less textbooks. The third school which mostly belonged to middle class parents had the system of getting only the right answer and no serious attention was given. The fourth one, which he called as the affluent professional school encouraged in individual thought and expression. The fifth one called executive elite schools which comprised children of the capitalist class, was the only school that worked on the development of analytical and intellectual powers through logical reasoning. Jonathan Kozol, a teacher who was being fired by a school for having his students read a poem that wasn’t prescribed in the list, does not disagree with the trend of this segregated school system (Kozol, 1991). He cites an example of a public school in New York which conducted classes in abandoned

Distinguished eighteenth century empiricist philosophers Essay

Distinguished eighteenth century empiricist philosophers - Essay Example The author has rightly presented that one of the most imperative of his doctrines includes the refutation of the (mis)conception that occurrence of two events or incidents contains some cause, which results into the happening of these incidents, as the effect of some cause that gives way to that the happening of the events. Hume, on the other hand, argues that since the magnitude as well as association between the cause and effect cannot be measured or estimated altogether, it would also be impossible to assert that happening of two events is the outcome of some cause. Thus, he does not perceive any cause in the occurrence of different events. Being a skeptic, Hume refuses to submit to the traditional notion about causation theory altogether subsequently. Nevertheless, it does not mean that Hume does not maintain any belief in causation; on the contrary, causation certainly exists, though it is unknowable; consequently, forming of complex ideas and different kinds of knowledge look f or either previous experience or analysis of the knowledge gathered or ascribed through any way. Here, the skeptic philosopher alludes to priori and posteriori knowledge, where the former is attained through experience, while the latter is abstract or intellectual one i.e. related to various disciplines like astronomy, science, mathematics and others. The philosopher cites examples of substances and abstract ideas in order to explain their development procedure and relationship with one another. Since Hume belongs to empiricist school of philosophical thought, he does not find the existence of any innate knowledge in humans. Contrarily, he divides the attainment of the same either through experience or through the application of senses while entering into interaction with the natural or social phenomena. Consequently, the individuals perceive the things in the light of either senses or experiences (539). Like Locke and Berkeley, Hume also declares application of senses as an unrelia ble source of perceiving the objects and phenomena, he views knowledge gained through the senses as inferior to the one that has been obtained out of experiences. However, both these ways may create errors and problems in respect of communicating the flow of information, and thus providing humans with appropriate knowledge as well. As a result, Hume suggests two different ways for getting knowledge and development of ideas in an apposite manner. Hume calls the ideas as spontaneous ones, which are permuted through imagination in order to change them into more complex form. Since the individuals do not have any experience about these complex ideas, which are actually the product of imagination, these developed ideas are unable to provide a clear concept of the objects related to the ideas (544). As a result, human creative power witnesses bar in respect of its extension, and hence turn out to be limited and narrower in the real sense. Complex ideas, in his eyes, are actually the produ ct of simple ideas, which could be stated as the dismal reflection of the simple impressions from which they are ultimately derived, to which they correspond and exactly resemble. In order to develop complex ideas on the basis of accuracy and true knowledge, by going through the process of composing simple ideas to change them into the complex ones, there must be the inclusion of experience, so that a mature and perfect picture of the situation could be drawn out of these simple and complex ideas. Since ideas are far less forceful than impressions,

Methods in the Assessment of Infertility

Methods in the Assessment of Infertility DISCUSSION 6. DISCUSSION 6.1 Fertility depends on the presence of normal fallopian tubes. Tubal factors have been reported to account for 25% to 30% cases of infertility. [6]Partial or complete occlusion of fallopian tubes is one of the major etiological factors in infertility. 6.2 In the present study, 60 cases attending Gyneac OPD in Department of Obstetrics Gynaecology at Base Hospital were studied. Among all cases of primary infertility was found to be 73.3% in present study and cases of secondary infertility was found to be 26.6%. (Table -5.1). Allahabadia et al (1992) studied 50 patients, out of which 40 (80%) had primary infertility and 10 (20%) had secondary infertility. [61] 6.3 The average age in primary infertility group, in present study was found to be 25.27 years while that in secondary infertility group was 28.83 years (Table: 5.2 5.3).Average age of all cases of infertility was 27.05 years. Tufekci et al (1992) studied 44 cases. The mean age of patients was 24.17 + 2.83 years (age ranging from 20 years to 35 years).The maximum number of cases i.e. 29 (65.9%) of primary infertility were in 21-25 years age group. In secondary infertility group, the maximum number of cases i.e. 8 cases (50%) were found to be in 26 30 years age group. [79] S. Kore et al, in their study had similar observation. Maximum numbers of the patients in his study were between 25-30 years of age, 34 patients had primary infertility and 6 had secondary infertility. Mean duration of infertility in his study was 5.2 years. [8] S lal et al, studied 100 patient of infertility and majority of the patients i.e. 64% of the women were cases of primary infertility and maximum number belonged to the age group of 26-30 years .[57] 6.4 The average duration of infertility in primary infertility group was 7.78 years, while that in secondary infertility group was 9.58 years (Tables 5.5, 5.6). The maximum number of cases i.e. 17 cases (38.7%) of primary infertility were infertile for 1-5 years whereas for 6-10 years (Table 5.5, 5.6) in secondary infertility group i.e. 9 cases (56.3%). Among all cases of infertility, the maximum number of cases i.e. 24 cases (40%) were infertile for 6 -10 years (Table – 5.7). Similar finding were also reported by A.K. P. Ranaweera et al. (2013); in which study population comprised 42 infertile women in Srilanka.[80] Overall, the mean age was 31.95 years, with a range of 24–39 years. Mean duration of infertility was 2.98 years, range 1–10 years. Infertility was reported as primary and secondary by 38 (90.5%) and 4 (9.5%), respectively [84]. Another study which was done by Aziz N. (2010) on infertility cases, where cases were taken by ratio of primary and secondary infertility as 2:1.Out of 50 patients, 32 patients (64%) presented with primary infertility and 18 patients (36%) presented with secondary infertility. The mean duration of infertility was 3.7 years and 7.3 years in primary and secondary infertility respectively, while mean age of presentation was 28 years in primary infertility and 32 years in secondary infertility. [68] 6.5 On transvaginal sonosalpingography, out of 44 cases of primary infertility, tubes were found to be patent in 30 cases and blocked in 14 cases (Table 5.8). These 30 cases of patent tubes included 5 cases which showed delayed spill on one side and free spill on other side. Out of 14 cases of tubal block, 6 cases (13.7%) showed bilateral tubal block, 4 cases (9%) each showed right sided and left sided block respectively (Table – 5.8). Out of 16 cases of secondary infertility, 8 cases (50%) showed bilateral tubal patency and 4 cases (25%) showed bilateral tubal block. 1 case (6.2%) and 3 cases (18.8%) showed left sided and right sided block respectively (Table 5.9). Out of all 60 cases of infertility, 38 cases (63.3%) showed bilateral tubal patency and 22 cases (36.7%) showed tubal block (unilateral/bilateral) (Table – 5.10). Tubal block was found to be more common in secondary infertility cases i.e. 8 (50%) as compared to primary infertility cases 14 (31.7%) (Tables-5.8, 5.9). Bilateral tubal block was more common in secondary infertility cases i.e. 4 cases (25%) as compared to primary infertility cases i.e. 6 cases.(13.7%) (Tables- 5.8, 5.9). Tufekci et al (1992) performed transvaginal sonosalpingography and accurately showed patency in 26 patients and bilateral non-patency in 3 patients. [79] Allahabadia et al (1992) performed The Sion Test in 50 patients and found bilateral patency in 41 cases, (82%), bilateral block in 6 (12%) cases, left block in 2 (4%) cases and right block in 1 case (2%). [61] Transvaginal sonosalpingography could also pick up additional findings. Cystic ovary was observed in 5 cases (8.3%) and fibroid in 3 cases (5%) (Table 5.11). 6.6 In Primary infertility group, out of 44 cases chromolaparoscopy showed bilateral tubal patency in 31 cases (71.4%) and bilateral tubal block in 6 cases (13.6%). Left sided block and right sided block was seen in 3 cases (6.9%) and 4 cases (9.1%) respectively (Table 5.12). Out of 16 cases of secondary infertility, chromolaparoscopy showed bilateral tubal patency in 9 cases (56.2%), which included one case which showed delayed spill on one side. Bilateral tubal block was seen in 3 cases (18.8%). Left sided block and right sided block was seen in 1 case (6.2%) and 3 cases (18.8%) respectively (Table 5.13). 6.7 Out of all 60 cases of infertility, chromo-laparoscopy revealed tubal block in 20 cases (33.3%) and bilateral tubal patency in 40 cases (66.7%) (Table 5.14). Tubal block was found in 7 cases (11.7%) in secondary infertility group as compared to 13 cases (21.7%) in primary infertility group (Table 5.14). Darwish AM et al study, where SHG agreed with laparoscopy for the patency of right and left tubes in 72.4% and 60.5% cases. [75] Allahabadia et al (1992) observed bilateral tubal patency in 41 cases (82%); bilateral tubal block in 6 cases (12%) left block in 2 cases (4%) and right block in 1 case (2%). [61] 6.9 Out of additional findings picked up by chromolaparoscopy in all cases of infertility, adhesions (peritubal / periovarian) were most commonly observed i.e. in 21 cases (35%). Cystic ovary and fimbrial cyst were observed in 4 cases each (6.6%) respectively. Fibroid was seen in 3 cases (5%). Tubo-ovarian mass, acute kinking of tube and endometriosis were seen in one case each respectively (1.6%) (Table 5.15). Aziz N (2010) observed tubal blockage in 21.9% and 33.3% cases of primary and secondary infertility respectively. Out of all 15.6% cases of primary infertility were detected as polycystic ovaries (PCO) which was not found in cases of secondary infertility. Endometriosis was found in 12.5% cases with primary infertility and 11.1% cases with secondary infertility. Pelvic inflammatory disease (PID) was found in 3.1% and 16.7% cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 6.3% cases with primary infertility and 22.2% cases with secondary infertility. Fibriod was found in 6.3% and 5.6% cases of primary and secondary infertility respectively. Ovarian cyst detected in 6.3% cases with primary infertility while none was found in cases of secondary infertility. [68] 6.10 A significant advantage of chromolaparoscopy over other methods of detecting tubal patency is that, it permits the visualisation of additional pelvic pathology, particularly pelvic adhesions. This is particularly relevant in assessing the feasibility of their surgical intervention. If dense pelvic adhesions are seen to be associated with totally disorganised tubes, laparotomy may not be indicated. This is of further value with reference to genital tuberculosis, as it presents a real diagnostic problem.Reliable diagnosis of genital tuberculosis is of significance not only to enable proper specific treatment, but also to avoid futile and possibly hazardous surgery.Inability to diagnose accurately the peri-tubal adhesions is an important shortcoming of transvaginal sonosalpingography. 6.11 The presence of peritubal and periovarian adhesions and that too, with high incidence is a significant finding in this study. It implies that adhesions can affect the tubal function with-out affecting the tubal patency. Adhesions affect the fallopian tube by restricting its mobility, interfering with ovum pick up and changing its peristalsis. Laparoscopy provides additional information concerning The site of adhesions whether peritubal or periovarian. b)The extent of adhesions. c)The effect on the course of the tube. d)Anatomical relation between fimbia and ovary Exact site of tubal block could not be diagnosed by transvaginal sonosalpingography.Out of 7 cases of tubal block in secondary infertility group, 2 cases (12.5%) each showed corneal block and midtubal block was seen in 1case (6.2%) and 4 cases (25%) showed fimbrial block (Table 5.17). 6.12 When results of transvaginal sonosalpingography and chromolaparoscopy were compared in all cases of infertility, 38 cases (63.4%), showed bilateral tubal patency by transvaginal sonosalpingography, whereas by chromolaparoscopy 40 cases (66.6%) showed bilateral tubal patency.Agreement regarding tubal patency was seen in 63.4% of cases. Regarding tubal block, agreement was seen in 33.4% cases. On the whole, agreement was seen in 96.6% cases (Table 5.18). Tufekci et al (1992) found completely consistent results in 76.32% of cases by transvaginal sonosalpingography and chromolaparoscopy and partially consistent results in 21.05% cases, and inconsistent results in 2.63% case. [79] Allahbadia et al (1992) performedSiontest and chromolaparoscopy in 50 patients. They found 100% agreement between the two methods for tubal patency. [61] 6.13 Comparison between transvaginal sonoslpingography and chromolaparoscopy in tubal block group (Table 5.19) showed that regarding bilateral tubal block, agreement was seen in 40.9% cases. Regarding unilateral tubal block, agreement was seen in 50% cases, and on the whole agreement was seen in 90.9% cases. Out of 60 cases 22 cases (36.6%) showed tubal block by transvaginal sonosalpingography whereas by chromolaparoscopy only 20 cases (33.4%) showed tubal block. Two cases were falsely picked up by transvaginal sonosalpingography as cases of tubal block. Jeanty P (2000) observed that Air-sonohysterography and laparoscopy with chromopertubation showed agreement in 79.4%. In 17.2% of patients, the tubes were considered nonvisualized by air-sonohysterography when they were patent. The sensitivity was 85.7% and specificity was 77.2%. [70] 6.14 One of the cases which showed right sided block by transvaginal sonosalpingography and bi-lateral tubal patency by chromolaparoscopy showed flimsy peritubal and periovarian adhesions and delayed spill on instillition of methylene blue dye from right side, when chromolaparoscopy was performed. The other case which showed bilateral tubal block by transvaginal sonosalpingography, showed apparently healthy tubes and free spill from both sides by chromolaparoscopy. This might be due to spasm which was relieved under general anaesthesia. Study has done by Tanawattanacharoen S et al. (2000) Shows corresponding results between HyCoSy and chromolaparoscopy in 80.0%. The agreement between both procedures in assessing the uterine pathology was 80.4% (68%). [77] Dietrich, M et al. (1996) find corresponding results with regard to the tube patency between HyCoSy and conventional chromolaparoscopy in 82.5% of cases .Right sided block was observed in 31.8% by both methods. Left sided block was seen in 22.7% by transvaginal sonosalpingography however chromolaparoscopy confirmed block in 18.1%. Percentage of false positive results as shown by transvaginal sonosalpingography was 4.6 %, whereas no false negative results were seen. [63] Allahabadia et al (1992) observed bilateral tubal block in 12%, left sided block in 2% by both Sion test and chromolaparoscopy. [61] 6.15 Divergent observations emphasize the difficulty encountered in accurate localisation. Cornual occlusion for example either functional or structural precludes any evaluation of the remainder of the tube. Furthermore, the patients with apparent cornual block may show a block at the ampulla on repeated film. Chromolaparoscopy revealed more of additional findings as compared to sonosalpingography (Table 5.15). 6.16 Comparison between these two methods in patients of tubal block showed that chromolaparoscopy was the most reliable method for diagnosing tubal block. Out of 22 cases of tubal block by transvaginal sonosalpingography, 2 cases showed patent tubes by chromolaparoscopy and only in 20 cases, the tubal block was confirmed. Level of agreement between these two methods regarding bilateral block was found to be 40.9%. Regarding unilateral block, agreement was seen in 50% cases. On the whole, agreement regarding tubal block was 90.9%.Sensitivity of transvaginal sonosalpingography was found to be 95 %, whereas specificity was found to be 100 %. There were no false negative results by transvaginal sonosalpingography whereas 5% results were false positive. Allahabadia et al (1992) found that transvaginal sonosalpingography showed bilateral occlusion with sensitivity of 100% and tubal patency with 96% specificity. [61] Sensitivity and specificity of transvaginal sonosalpingography as diagnostic test for tubal patency by various studies: The results of this study confirm that both transvaginal sonosalpingography and chromolaparoscopy constitute valuable methods in the assessment of infertility. Though, superiority of chromolaparoscopy over transvaginal sonosalpingography has been clearly demonstrated but the 2 techniques should be considered complimentary and not as a substitute for each other. Transvaginal sonosalpingography can safely replace HSG for determining tubal patency as a routine diagnostic procedure. Trans-vaginal sonosalpingography when compared with HSG: Is more accurate in demonstrating the presence of tubal patency Is potentially safer. Is potentially more convenient and less expensive. Idiosyncracy to contrast agent cannot be expected. Can be performed on ambulatory basis. Trasvaginal sonosalpingography can be criticized on the grounds that- Exact site of tubal block cannot be determined Peritubal adhesions and mobility of tube cannot be properly assessed. It does not provide an accurate assessment of intrauterine and tubal anatomy. It is advocated that young women, as a first examination for fallopian tube patency, should undergo transvaginal sonosalpingography of the pelvis. If tubal patency is demonstrated, the patient should be recommended a six month trial period to become pregnant before invasive procedures are initiated. Chromolaparoscopy should be a vital part of the investigation in all cases of unexplained infertility as it may document hitherto unsuspected pelvic pathology. It is also an essential step former to any tubal surgery at it may not only preclude the requirement of operation but may also provide essential information regarding the nature and extent of future surgery. It is observed again that transvaginal sonosalpingography is not a substitute for chromolaparoscopy; it is offered as a screening test which is very cheap, noninvasive, simple, and cost effective with no infectious morbidity. It is a promising screening and diagnostic technique in evaluation of tubal patency on an ambulatory basis. 1