Radiation Exposure In Intraoral Radiography Health And Social Care Essay

Radiation Exposure In Intraoral Radiography Health And Social Care Essay Dental radiography is one of the most frequent types of radiological procedures performed. One of the projections that have been done in the dental radiography is the intraoral radiography, which means the film is put inside the patients mouth. The intraoral can be divided into four, which are bitewing view, periapical view, occlusal view and full mouth series. There are conventional intraoral radiography and another one, with the advances in technology, the digital intraoral radiography is been developed. In this new imaging modality, the radiographic film is replaced by a sensor for the X-rays. The signal temporarily stored within the sensors is transferred to the computer, which displays an image that may be filed, interpreted, manipulated and quantified. The digital intraoral radiography is divided into two, which are two fundamentally different concepts for direct digital image acquisition, the CCD-based (charge-coupled device) and the Storage Phosphor systems. The intraoral radiography is said to have a low exposure dose received by the patients. According to the several sources that can be trusted, the exposure dose received by the dental patient equivalent to a few days worth of background radiation environmental radiation exposure or similar to the dose received during a cross-country airplane flight. Digital dental radiography is more preferable because although film has been an inexpensive and reliable image receptor in dental radiography for a long time, the advantages of digital dental radiography over film include providing a lower radiation dose, a swift availability of radiographs, the possibility of image enhancement and no need for film processing chemicals. DOSES IN INTRAORAL RADIOGRAPHY In digital intraoral radiography, the mean exposure time and radiation surface dose for the PSP is greater than that for the CCD system by a factor of 2.45. However, there was also a significantly higher repeat rate using the CCD system compared to the PSP system. Therefore, despite the CCD system requiring more repeat exposures, the radiation received by the patient is less. CCD systems showed a larger dose reduction in comparison to PSP imaging plates. Another study reported that the dose reduction as a result of shorter exposure times exceeded the increase in doses as a result of the greater number of radiographs with both digital systems. However, with the CCD sensors the dose reduction per exposure was almost cancelled out by the increase in the number of radiographs taken. Although the patient exposure associated with dental radiography is relatively low, intraoral radiography should be optimised in order to keep the radiation risk as low as reasonably achievable, something that is widely known as the ALARA principle but at the same time, produce a best quality of image. Any radiological procedure should be justified and modified in order to keep the radiation risk as low as reasonably achievable, especially to the children. Compared to adults, children are more sensitive to the radiation exposure. Dose assessment is recommended to be performed on a regular basis to ensure that patient exposure is always kept within the recommended levels and at the same time, the malfunction of the equipment also can be detected. All radiological procedures carried out on children must adapt to special radiation protection measures, which aims at recognising and implementing possible dose reduction strategies in order to eliminate unnecessary and therefore unjustified radiation exposure. Over the past 20 years both the X-ray units and the X-ray receptors used in dental radiology have been evolved. Modern dental X-ray units incorporate high frequency generators, operate at higher tube potentials and produce X-ray spectra that have higher mean energy and therefore are more penetrating compared to those produced by older dental X-ray units. These improvements have contributed in the reduction of the radiation dose to the e ntrance skin surface of the patient and the enhancement of image quality. According to Hart (2009), the new adult reference dose for intra-oral radiographs (2.3 mGy) is 40% lower than the 1999 value (4 mGy), probably owing to the use of faster film-screen and digital systems. This is the first time that a national reference dose for intra-oral radiographs on children has been recommended (1.5 mGy), and it is, 35% lower than the corresponding adult value. Some studies show that there is a large dose variation between different X-ray units used for the same radiographic projection and it is relatively low. However, although radiation exposure from intaoral radiography is considered to be low, the patient may have a chance to undergo repeated dental radiological procedures. Therefore, the accumulated effect of the radiation exposure should be taken into consideration. Salivary gland and the thyroid gland are among the organs at risk in dental radiology. Salivary gland, which often lies within the primary beam in intraoral radiographic projections has been shown to receive dose from 0.02 mGy up to 0.1 mGy per examination. As stated by Looe et al. (2006), dose received by the thyroid gland, mainly due to scattered radiation, is comparably less than those received by the salivary glands. On the other hand, the thyroid gland is one of the most radiosensitive organs for children and dose imparted on the thyroid gland should be minimised whenever possible. Diagnostic reference levels (DRLs) have been introduced by the European Union in the Medical Exposure Directive (MED) (97/43/Euratom). The directive requires the member states to promote the establishment and the use of DRLs and to ensure that implementation guidance is available (Poppe et al., 2006). A good practice is established when the required levels are not exceeded. The DRL is very important because inadequate techniques or machine malfunctions in the case where they are consistently exceeded can be detected during the examination, so that appropriate corrective action could be undertaken. Patients increased their chance to be subjected to unnecessarily high-radiation doses due to unsatisfactory equipment or inadequate techniques. To establish the DRLs, entrance surface dose (ESD), dose area product (DAP) or other dose-related quantities may be used. In the intraoral radiography, DAP has been chosen as the measurement quantity as it could be measured without the patient in place and the field size of the beam is directly reflected on the measured value. Rectangular collimator is preferable compare to the cylindrical collimator because the rectangular one can fit the size and shape of the film better, eventhough most X-ray units in intraoral radiography is equipped with cylindrical collimators. Furthermore, the introduction of DRLs has lead to DAP meters being installed as an integral part in radiology equipment used for the automatic registration of patient dose. The DAP meters could also be a possibility for panoramic units. It is completed with the advent of digital radiography and the use of automatic exposure control for these examinations, so, such equipments would allow easy monitoring and follow-up of i ndividual patient doses. It has been suggested that this dose area products are closely correlated with effective doses under specific circumstances because DAP are directly measurable or indirectly accessible from exposure. In instance, Poppe et al. (2006) stated that the measured DAP values for maxillary molar examinations range from 3.8 to 134.8 mGy cm2. The minimum dose measured for non-digital systems was 17.4 mGy cm2 and the maximum value measured was 134.8 mGy cm2. The highest third quartile value was calculated for occlusal examinations, whereas the lowest value was calculated for mandibular incisor examination. Moreover, there is a large difference between patient exposures among different dental facilities. Sometimes, the differences are up to a factor of 35 for the same examination. This s due to the inconsistencies of radiological practices performed in clinical routine such as different X-ray units, exposure techniques, film speed or even inadequate exposure setting and film developing procedures, and further. It can be seen that many dentists do not preferable using the dose-optimized programmes for the faster films. In addition, the correlation between DAP and tube loading may also be used as a rule of thumb in determining the imparted dose on patients. Thats why it is necessary to have the DRLs laid out as guidelines. In intraoral radiography, periapical is the most commonly performed and usually two to four teeth are shown on the image providing full tooth structure, including pulp, root and gum anatomy. On the other side, bitewings are taken to show the upper and lower teeth together on a single image while occlusal radiography demonstrate the dental arches at right angles to the occlusal plane. Although DRLs are useful in optimising radiological procedures by identifying inadequate exposure techniques, they still got the disadvantage. The problem is, they are lacking information in the risk associated with the radiological procedure. So, the other alternative is by using the conversion coefficient. It is used to estimate effective doses from DAP values have been published for common radiological procedures, including in intraoral radiography. In intraoral radiography, basically, thyroid gland and brain tissue receive only a small fraction of dose caused by scattered radiation within the phantom except for occlusal examination of the maxilla where high dose was measured at the brain tissue. So, we can say that overall skin dose is also relatively low as only a small fraction of skin was exposed directly to the x-ray beam. Moreover, salivary gland which often lies within the primary beam is exposed to high dose during intraoral examinations. This gland received highest dose followed by the red bone marrow. Then, the mandibular angle also was exposed to a high exposure during most of the dental examinations. Doses measured at the thyroid gland and brain tissue were only attributed to scattered radiation and therefore considerably low. However, only low dose was recorded at the third cervical vertebra mainly due to scattered radiation. The other factor that determines the exposure dose in the intraoral radiography is the type of film. It is remarkable that several facilities using an E or F speed film have higher doses than other facilities using the less sensitive D-speed films. For example, in the category of dentists using X-ray units operating at 65 kV, the lowest dose measured using D-speed film is 3.5 times lower than the highest dose measured using E or F speed film. However, the exposure time for the digital radiographic systems was set to 10-50% of that of E-speed film in most cases of intraoral radiography. However, in some clinics and hospitals, working with faster film type or higher tube voltage is not always associated with lower exposure. Many precaution measures could be taken at no cost to reduce the patient exposure by choosing the appropriate exposure parameters. Operators of X-ray units shall pay special attention to ensure that the right radiological equipment and techniques are used when performing radiological procedures on the dental patient. When using the faster film types, the operator should reduce the exposure time, so that the level of radiation exposure received is not beyond with the acceptance level of radiation exposure in intraoral radiography. Still, it is very important for the technologists to be informed about the necessity and importance of reducing the exposure times when working with the faster film types The quantitative aspects of radiation doses is needed to observe and determine the necessary radiation protective measures and at the same time, can help the general public to allay radiation fear in dental radiography. Because, it is afraid to develop certain disease and the highest risk in intraoral radiography is leukemia and thyroid cancer, even in doses as low as 500 mSv. On the other hand, even low doses of radiation can cause changes in the DNA of the cell that may not be lethal but that could cause the mutations that could lead to cancer. Most of these DNA changes are discovered and repaired before they cause problems, but the repair mechanism is not perfect and some of the changes may persist and accumulate. Non-repairable damage is more likely to occur with higher doses or dose rates but there is a chance that even a single small hit of radiation could produce a mutation that could cause cancer. The more radiation a person is exposed to, the more chances he has of receiving a non-repaired DNA injury. Similar surveys conducted in dental radiographic facilities over the last 10 years have demonstrated a trend for reduction of the ESD, with the use of faster films and digital receptors, as well as with modern x-ray units and rectangular collimation. The emphasis should be increased to the structures located in the oral region, particularly the salivary glands. At the gonadal areas, the gonads are not in the line of exposure, especially during intra-oral or panoramic radiography. However, the dose to the genetic cells results from scattered radiation in dental radiography. Scatter radiation during dental radiography may result in exposure of the dental personnel in the area. A dentist or dental auxiliary may accumulate perceptible amounts of radiation doses from his repeated exposure to scatter radiation. The precaution also must be highlighted to the pregnant women because the excessive exposure dose received by the pregnant women may result in spontaneous abortion, congenital abnormalities, microcephaly and decreased mental efficiency. From the study by Brooks (2008), shown that the doses actually used to obtain dental radiographs are frequently higher than what can be obtained in ideal situations. For example, a recent study done in Spain that measured entrance doses in several thousand dental offices reported that there was frequently no difference in radiation dose with different films and in different locations within the mouth. According to the revised recommendations for calculating effective dose, dental radiography involves 32% to 422% more risk than that previously thought. Therefore, efforts should be made to reduce dose as much as possible but not at expense of image quality and diagnostic accuracy. In addition, different groups of teeth need different exposure times for obtaining quality diagnostic information. Moreover, the patient dose is determined not only by the amount of radiation per exposure, but also by the number of radiographs taken. A recent study shows that the total number of radiographs taken by dentists using digital radiography was significantly larger than the number of radiographs taken by film users. The number of radiographs taken by dentists using solid-state systems compared to film-users while phosphor plate users took 32% more radiographs. The main reason when taking more radiographs is to achieve better diagnostics and description about certain condition of the patient. Eventhough it provides better diagnosis, positioning errors occurred more often in digital radiography than in film-based radiography. This is due to the stiffness of the digital sensors that is significantly more difficult to position in the patients mouth, rather than the positioning film and more uncomfortable for the patient although. CONCLUSION In conclusion, digital intra-oral radiography is a well-accepted diagnostic tool in dental practice. However, some of the claims made by manufacturers of digital systems, are not valid to their full extent. For instance, the dose reduction per exposure is real, but it is still to be determined what the actual dose reduction is because of the fact that dentists tend to make more radiographs when using a digital system. Sometimes, the importance of the level of exposure dose received by the dental patient is underestimated. Due to this, it could lead to the poor characteristics of x-ray device, inadequate film processing conditions and outdated techniques used. Regular quality control of dental x-ray units can eliminate deficiencies related to equipment. Inadequate technique is a more significant problem, because dentists and radiology technicians are insufficiently educated in the field of radiation protection. Because of that, it is best to select the imaging technique that will provide that information with the lowest radiation dose. To obtain that, dental equipment must stay in good condition, including film processing apparatus and solutions, and use good technique to avoid retakes. In addition, using fast film or digital imaging and small collimation, whenever feasible, will also keep the radiation dose as low as reasonably achievable, or ALARA which is a goal worth pursuing. in general, both entrance and effective doses are reduced when higher film speed (E-speed or F-speed instead of D-speed) or digital imaging is used. In addition, rectangular collimation of the beam also reduces the effective dose because less tissue is exposed in total. There are no such things as necessary routine radiographs the way there are required. Instead, dentists must make radiographs only when they think they are necessary to make an accurate dental assessment or diagnosis to reduce the number of X-rays taken to the minimal needed for dental health. Efficient implementation of the basic principles of radiation protection, particularly which the practice optimization through the quality assurance program, is the only adequate way of reducing the patient dose and at the same time, preserving the quality of diagnostic information.

My most successful writing experience Essay

Every individual would have someone they look up to, a role model that would help shape and mould them into becoming a better person. If I am in any way a better person then I was, I owe this to my late father. It is indeed because of him, I am who I am today. He knew my every flaw yet he saw the good in me. I was indeed my daddy’s little girl and always wanted to remain that way. I saw a friend in him and not just a father figure. In him I could confide and be open just about anything. He gave me everything one could possibly ask for, not just material but guidance and advice. He had always tried to make me into a better person, never failing to support my dreams and ambitions. One thing I am grateful for is that he always made me feel that I was the best gift he has ever received from God and that taught me to make others feel appreciated. My father taught us godliness till the day he died. He believed in forgiveness and being humble. Through him, I have also learnt to be optimistic in everything and that no matter how bad things may seem, there is light at the end of the tunnel. With him being gone, the only thing that consoles me is that I am lucky I had a great father like him unlike other unfortunate children who never had parents. Upon finishing high school, I made a list of colleges that I was planning to enroll into and frankly, Segi College wasn’t top five. But the moment I stepped foot into the campus, I cannot describe how much I love being here. My first few weeks of college have been pretty amazing; my classes are interesting, my lecturers are laid back and the feeling here is incredible! My first impression of college was that it was going to be a lot like high school, except that there would be more work and assignments of course. I was expecting that coursework would be insanely difficult and would be impossible to complete. However, I have handed in a few tasks on time and trust me, there is no better feeling than handing in an assignment that you have been slaving on for a while! I am looking forward to meeting new people in class and joining clubs that the college has to offer. It is harder to make friends in college because people do not really talk to each other but I am sure if I open up a little bit and swallow my pride I will make friends much easier. I believe that the next four years will really be the best years of my life. I remember that day, and why it was so dark and melancholy. Everyone spoke in  silence, some had tears in their eyes that even a smile given was only to condole one another. Being the oldest child, I was to give a eulogy at my daddy’s funeral and despite having many good things to say about him, I was dumbstruck. I sat in my room, with paper and pen in my hand, gazing aimlessly across the room until a little blue book caught my eye. There it was, sitting on my desk, my journal which has been a habit of mine ever since I could remember. I would write a lot, out of joy, of anger, of sorrow and even out of boredom. I picked it up and flipped through the pages. Tears started rolling down my cheeks. In it, I had bittersweet memories of my daddy, the ones that could make me laugh or even frown. It was almost like an entire Facebook timeline of my life with his presence in it. I could hear the pastor calling out for the funeral service to begin. Instantly, I started scribbling my eulogy on the piece of paper. I suddenly knew what to say. Silently, I thanked my journal. It may not be the best reading material but it was definitely one I am thankful for and proud of. The one that taught me, keeping a note on the smallest things in life might be a blessing in the future.

An Analysis of New York City in Martin Scorsese’s Essay

Among the stellar names in the film directing profession in the world, Martin Scorsese’s is most likely near or at the very top of the list—as bright as the city he has chosen to showcase in most of his career pieces. Using New York City as his backdrop, Scorsese has created landmark films that explore the intricacies of specific human qualities, tightly connected to themes of identity, religion, and psychology. Three of his films—Mean Streets, Taxi Driver, and Life Lessons—bear the distinct signature of an artist with an immediate message, which is clearly influenced by the dynamics of the inimitable lifestyle of New York City. A native of Flushing, New York, Martin Marcantonio Luciano Scorsese started planning his life as a priest—which is not at all surprising, considering his Italian and Catholic upbringing. However, he shifted goals at some point and graduated with a film degree from New York University in 1964, when he was twenty-two. Soon after that he became involved in film productions under the tutelage of several directors and producers, and finally emerged with his first notable feature film, Mean Streets (Brown, 1996). This particular work signaled the birth of Scorsese’s iconic style, which is defined by idiosyncratic characters and their internal struggles, marked by various circumstances exposing violence, racism, and oppression. Religious topics and details are also common in Scorsese’s work, which, in the past, received the ire of staunch religious groups. Scorsese is also known for building the careers or collaborating with specially-chosen actors, such as Robert De Niro, Harvey Keitel, and, in recent years, Leonardo DiCaprio. Each of these actors has starred in at least one iconic Scorsese film: De Niro and Keitel in Mean Streets and Taxi Driver, and DiCaprio in The Aviator and Gangs of New York. Common among most of these films is still the appropriation of New York City as the influential setting in playing out each character’s goal and dilemma. Credibility and accuracy in portraying the life inherent in New York City are integral in Scorsese’s work, and the nature of the city as a melting pot of cultures and its reputation for being the end goal of all personal ambition provide more than enough motivation and reason for the many twists and turns that take place in the characters’ minds and on the streets. II. Living the Gangster Life: The Italian Identity in Mean Streets One of the most definitive of New York City’s life and color is the presence of a multitude of cultures; this is largely caused by the representation of immigrants from all over the world, who have brought with them the distinct traditions and values of their countries of origin. The Italian community is mainly known for its influence on New York City cuisine, religion, and, as historically documented, organized crime in the form of the Mafia. Mean Streets is inherently Italian in identity, as it is set in New York’s Little Italy in the early 1970s—the territory and environment of most known Mafia-gangster groups. The portrayals of Charlie and his friend Johnny Boy—Keitel and De Niro, respectively—are excellent examples of life within the gangster reality, of non-negotiable orders, surprises and sudden decisions, the possibility of assault and instant death. This kind of life, however, is not always chosen by those who find themselves in it; Charlie, for one, lives by the dictates of family and religion, and refuses to take a stand on anything—even if he is plagued by his own guilt. Johnny Boy, on the other hand, is the quintessential gangster, the product of family legacy and history and his pleasure in romanticizing violence and aggression. These two personas reveal some of the most prevalent yet opposing attitudes regarding life in New York City—the struggle to accept a predetermined career, and the assertion of identity based on others’ experience. New York City is indeed a complex mixture of culture and identity, and these are often appropriated by those who desire to make their voices heard in the din of success, failure, and everything else in between. Religion, ethnicity, family, and other inherent traits that contribute to create an identity that can set one apart from the faceless rest are apparent means for survival, which is essential in the midst of such an unforgiving address. III. Left Alone and Unnoticed: Idealism, Racism, and Violence in Taxi Driver De Niro’s portrayal of Travis Bickle in Taxi Driver symbolizes the outcome of a person left to survive on his own in the complicated maze that is New York City in the mid-1970s. What begins as a man with fervent dreams of success and fulfillment in the capital of realized wishes can end in cynicism, hopelessness, and despair. Idealism sets the pace for the ultimate acts of violence and racism, played out by succeeding episodes of rejection and perceived injustice—specifically in the context of sex and acceptance. Bickle’s downward spiral into madness is caused by his own set of values, which includes his idealization of women, superiority of race, and self-entitlement coming from the war experience. Finding himself in a world where he is rejected by a woman he admires, where immorality and child prostitution exists, and where blacks are shown to call the shots through violence and extortion, are enough to shape Bickle’s concept of reality and purpose. Ultimately, he decides to take matters into his own hands, in a defining act that finally pronounces his voice and presence. Rejection and disappointment are part of the New York City lifestyle, given the constant struggle and competition naturally occurring within such a lucrative environment. Likewise, the reality of prostitution and other forms of immorality are necessary effects of the ongoing tests of one’s desired fate, since negation and failure will always need a stopgap measure and means for release or revenge. This complicated economy may not always be easy to comprehend, much less seen as one’s way of life; that Bickle is established with traits akin to surreal idealism makes New York City a symbol of both fulfilled dreams and unrealized goals. Bickle’s persona is common among many who have decided to find their success in the city yet is only armed with traditional ideals of morality, justice, and equality. Race is an evident issue, particularly if it figures in the equation of opportunity and chances for success; blacks, to the white Bickle, represents all things he finds wrong in the city. Finding people of a different set of morals is also a trigger for Bickle’s downfall, since he finds himself unable to impose his own ideals on them. New York City is shown here in its element, with the images of political action and objective during the day and graphic evidences of violence and the sex trade at night. These two pictures of the city plainly show that it is not for the weak, nor for the idealistic; what is essential is toughness and open-mindedness in order to understand the nature of New York City as a place where everything can and will happen. IV. The Master and the Servant: Creativity and Political Economy in â€Å"Life Lessons† This installment in the bigger project that is New York Stories is Scorsese’s contribution to the collective efforts made with fellow film icons Francis Ford Coppola and Woody Allen. â€Å"Life Lessons† is a simple story about artist Lionel Dobie, played by Nick Nolte, and his lover/apprentice Paulette, portrayed by Rosanna Arquette, who both engage in the literal and figurative significance of a two-way relationship. Dobie, being a famous abstract artist, imparts his knowledge, skill, and social connections to Paulette, who in turn repays him by serving as his muse and sex partner. Their relationship comes to a turning point when Paulette decides to move on and see other men, which causes Dobie to become insanely jealous. But it is this jealousy that eventually drives him to create his best work, and thus he forces Paulette to stay with him by selling her on the idea that New York City is the only place for an aspiring artist like herself. Evidently, Dobie lives on his negative emotions to survive, and has done exactly the same in his past relationships. In the end, Paulette makes good with her original decision and leaves, and soon Dobie is shown meeting another young female artist whom he convinces to become his new apprentice. This scene is shown with much sexual connotation, leaving the viewer to conclude that Dobie has once more found his muse. Art is never just for art’s sake in New York City; while some of the best minds are indeed residents of the locale, the competitive conditions and social norms that define it are also necessary factors to consider in appraising one’s success. Talent is never just the sole requirement in making it big in New York City, mainly because of the sheer number of individuals of excellent gifts trying to make names for themselves. Thus this brings about the reality and importance of social connection and status; in order to succeed in a place abound with skill and opportunity, one must look beyond the singular benefit of talent and employ all possible elements that can directly or indirectly help realize his or her goal. In this kind of situation, not everyone asked to assist will want to do so without claiming anything back—after all, the brand of opportunity existing in New York City is essentially available whenever and wherever one sees fit to call it forth. Intrinsically, New York City is probably the one significant environment where making and dealing transactions is the name of the game; to participate, one must have something to sell and/or buy. V. Conclusion Martin Scorsese’s depiction of New York City in the three films mentioned is, quite understandably, based on his own perceptions and experiences. These bases, however, are truly authentic and real—enough to convey a significant concept of New York City, as well as its nuances. The appropriation of identity in Mean Streets, idealism in Taxi Driver, and creativity in â€Å"Life Lessons† is truly apt and relevant, considering that these three themes are probably the most prevalent notions that define the city, albeit taken to each theme’s extremes. New York City may result in an assertion of identity or its eventual loss, depending on a person’s chosen path or decisions. It could progress the concept of idealism to its highest degree, particularly when success is met and values are replicated, yet it could also result in the erosion of idealist thinking, if all experiences are negative and disappointing. Lastly, the New York City experience can stimulate one’s creativity, since it is the one of the world’s capitals of art, yet can also diffuse the fire that burns one’s passion, if the right connections and exposure are not met. Nothing can be simply in the middle ground with regard to life in this city, as most things either fulfill or destroy existing beliefs and objectives. New York City is truly an enigma, a place that exists both in the mind and in its physical sense; while these two spaces may not always have the same traits or premises, the fact remains that it is an aspiration, where one should ‘make it’. Scorsese’s attempts at putting together a credible representation of New York City is laudable, but in truth, many more interpretations are still waiting to be conveyed. Such is the meaning of convergence, where anything and everything is possible. References Brown, M. (1996). â€Å"Martin Scorsese†. God Among Directors. Accessed on 10 April 2009 from http://www. godamongdirectors. com/scorsese/index. shtml Scorsese, M. (dir. ) (1989). â€Å"Life Lessons†. New York Stories. Touchstone Pictures (1973). Mean Streets. Taplin-Perry-Scorsese Productions. (1976). Taxi Driver. Bill/Phillips.

Analysis Of The Gilded Age And Progressive Era - 1108 Words

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